Food allergy and eosinophilic esophagitis: Learning what to avoid

Hong, Sandra; Vogel, N.M.

doi:10.3949/ccjm.77a.09018

Cited by 15 publications

(12 citation statements)

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“…Children with EE often have other associated allergic diseases such as allergic rhinitis, bronchial asthma, atopic dermatitis, and food allergy [8–10]. Food allergy in children has been linked to EE [22]. In this study, evidence for food allergy was obtained by testing for food-specific IgE antibodies in the serum in 10 patients and by skin prick testing in 11 patients.…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic Esophagitis in Children from Western Saudi Arabia: Relative Frequency, Clinical, Pathological, Endoscopic, and Immunological Study

Saadah

Aburiziza

Shakra

2012

Gastroenterology Research and Practice

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Background and Purpose. Eosinophilic esophagitis (EE) is an evolving allergic disease with an accelerated incidence. The purpose of this study was to delineate the relative frequency and clinicopathological characteristics of EE in children from western Saudi Arabia. Methods. Children with EE were studied retrospectively between October 2002 and December 2011 at King Abdulaziz University Hospital and International Medical Center. Results. The relative frequency of EE was 0.85% of 2127 upper gastrointestinal endoscopies performed during the study period. Eighteen patients were identified with EE. The median age was 8.6 years (range, 1.5–18 years). Thirteen (72.2%) were males. Dysphagia and vomiting were the most common symptoms. Ten (55.6%) children had history of atopy. Testing for food allergy by skin prick test was positive in 11 (61.1%). The most common endoscopic abnormalities were mucosal longitudinal furrow and loss of vascular pattern followed by patchy specks and strictures. The histopathological findings included increased intraepithelial eosinophils, eosinophilic degranulation, lamina propria fibrosis, and eosinophilic microabscesses. Treatment was initiated by swallowed topical corticosteroids in 12 (66.7%) and oral prednisolone in 6 (33%) patients, followed by low dose of topical corticosteroids and dietary elimination. Conclusions. Eosinophilic esophagitis is an uncommon but evolving problem. A high index of suspicion is required for early identifications and intervention to avoid possible complications.

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Section: Discussionmentioning

confidence: 99%

Eosinophilic Esophagitis in Children from Western Saudi Arabia: Relative Frequency, Clinical, Pathological, Endoscopic, and Immunological Study

Saadah

Aburiziza

Shakra

2012

Gastroenterology Research and Practice

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“…In patients with allergic disease, negative SPT responses have a negative predictive value (NPV) of 95% to 100% for 4 common allergenic foods: egg, milk, peanut, and fish 23, 24 . However, the specificity of this test is approximately 50%, making positive results especially difficult to interpret 25 . Because EoE is thought to be primarily non-IgE-mediated, skin testing based on delayed hypersensitivity to foods via atopy patch tests (APTs) has been advocated 7, 26, 27 .…”

Section: Introductionmentioning

confidence: 99%

Comparative dietary therapy effectiveness in remission of pediatric eosinophilic esophagitis

Henderson

Abonia

King

et al. 2012

Journal of Allergy and Clinical Immunology

248

239

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Background Eosinophilic esophagitis is a chronic, immune-mediated inflammatory disorder that responds to dietary therapy; however, data evaluating the effectiveness of dietary therapeutic strategies is limited. Objective This study compared the effectiveness of three frequently prescribed dietary therapies [elemental, six-food elimination, and skin prick and atopy patch-directed elimination] and assessed the remission predictability of skin tests and their utility in directing dietary planning. Methods A retrospective cohort of proton-pump inhibitor-unresponsive, non-glucocorticoid-treated eosinophilic esophagitis patients who had two consecutive endoscopic biopsies associated with dietary intervention was identified. Biopsy histology and remissions (< 15 eosinophils/high-power field) following dietary therapy and food reintroductions were evaluated. Results Ninety-eight of 513 patients met eligibility criteria. Of these 98, 50% (49), 27% (26), and 23% (23) received elemental, six-food elimination, and directed diets, respectively. Remission occurred in 96%, 81%, and 65% of patients on elemental, six-food elimination, and directed diets, respectively. The odds of post-diet remission vs. non-remission were 5.6-fold higher (P=0.05) on elemental vs. six-food elimination, 12.5-fold higher (P=0.003) on elemental vs. directed, and were not significantly different (P=0.22) on six-food elimination vs. directed diets. Following 116 single-food reintroductions, the negative predictive value of skin testing for remission was 40%–67% (milk 40%, egg 56%, soy 64%, and wheat 67%). Conclusion All three dietary therapies are effective; however, an elemental diet is superior at inducing histologic remission compared with six-food elimination and skin test-directed diets. Notably, an empiric six-food elimination diet is as effective as a skin test-directed diet. The negative predictive values of foods most commonly reintroduced in single-food challenges are not sufficient to support the development of dietary advancement plans solely based on skin tests.

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“…Igualmente, la inflamación prolongada por la eosinofilia, da lugar a la remodelación del tejido, caracterizado por hiperplasia del epitelio y músculo liso esofágico, fibrosis subepitelial y angiogénesis. Estos cambios patológicos, pueden causar complicaciones graves, como la creación de anillos esofágicos y originar alteraciones de la motilidad, que son responsables de la disfagia (42)(43)(44).…”

Section: Presentación Clínicaunclassified

Allergic reactions: key aspects and new perspectives

Restrepo¹

2016

An. Fac. Cienc. Méd. (Asunción)

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RESUMENLas reacciones alérgicas son una respuesta inmune exacerbada a un alérgeno en un individuo atópico. En éstas, influyen dos factores el genético y el ambiental. Con base en lo anterior, la Organización Mundial de Alergia determinó como enfermedades alérgicas al asma, rinitis, sinusitis, conjuntivitis, anafilaxia, alergia a medicamentos, alimentos, animales, insectos y hongos, eczema, urticaria y angioedema; las cuales han aumentado en el último tiempo, convirtiéndose en un problema de salud pública con repercusiones económicas exorbitantes. Asimismo, se han dado avances tanto en el diagnóstico, cuyos pilares siguen siendo la historia clínica, la medición de inmunoglobulina E específica y pruebas cutáneas; el tratamiento y las bases genéticas, que cada vez son más relevantes en el manejo clínico de estas entidades.Palabras clave: Alérgeno, ambiente, atopia, genética, reacción alérgica. ABSTRACTAllergic reactions are an exaggerated immune response to an allergen in atopic individuals. In these, two factors influence: the genetic and environmental. Therefore, the World Allergy Organization determined as allergic diseases asthma, rhinitis, sinusitis, conjunctivitis, anaphylaxis, drug allergy, foods, animals, insects and fungi, eczema, urticaria and angioedema; which have increased in recent times, becoming a public health problem with an exorbitant economic burden. Also, there have been advances in diagnosis, whose pillars are still medical history, measurement of specific immunoglobulin E and skin tests; treatment and genetic basis, which are increasingly important in the clinical management of these entities.Key Words: Allergen, environment, atopy, genetic, allergic reaction. INTRODUCCIONEl término reacción alérgica o hipersensibilidad se refiere a una respuesta inmune exacerbada o inapropiada del individuo predispuesto genéticamente o atópico, que se da en presencia de un alérgeno específico, definido como una molécula proteica vegetal, animal o fúngica que induce la

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Food allergy and eosinophilic esophagitis: Learning what to avoid

Cited by 15 publications

References 59 publications

Eosinophilic Esophagitis in Children from Western Saudi Arabia: Relative Frequency, Clinical, Pathological, Endoscopic, and Immunological Study

Eosinophilic Esophagitis in Children from Western Saudi Arabia: Relative Frequency, Clinical, Pathological, Endoscopic, and Immunological Study

Comparative dietary therapy effectiveness in remission of pediatric eosinophilic esophagitis

Allergic reactions: key aspects and new perspectives

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