Food-Specific IgG4 Is Associated with Eosinophilic Esophagitis

Abstract

RATIONALE: Eosinophilic Esophagitis (EoE) has been etiologically associated with egg, milk, and wheat allergy. Non-traditional allergens are being increasingly identified in EoE. We aimed to identify sensitization patterns to aeroallergens and food, and associations with pan-allergens, in an EoE population. METHODS: A case-series analysis of skin test results from 66 EoE patients meeting IRB/study criteria was performed. Associations between sensitization to pan-allergens, profilin/PR-10 and sensitization to aeroallergens and foods were determined via Chi-square tests. Entomophilous plant extracts (Locust; profilin, Alfalfa; PR-10, and non-native Ailanthus; profilin) were used as pan-allergen markers. RESULTS: 73 % of our EoE patients (aged 2-73 years; mean 5 16 years; 56% male) were sensitized to both aeroallergens and food. 18% were sensitized solely to aeroallergens and 1.5% solely sensitized to food. 86.4 % patients were pansensitized (> 3 aeroallergens). Overall, patients were sensitized to an average of 20.4 (SD514.9) aeroallergens and 6.3 (SD56.5) foods. Sensitization to egg (12/60, 20%), milk (8/62, 13%) and wheat (4/58, 7%) was less than anticipated, and sensitization to unique, pan-allergen containing foods: mustard (14/36, 39%), sunflower (15/25, 60%), garlic (12/45, 27%), and corn (12/46, 26%) was observed. Sensitization to unusual foods, along with legumes and tree nuts, was significantly associated with sensitization to PR-10 (p<0.05) and profilin pan-allergen markers (p<0.05). CONCLUSIONS: Novel findings in our EoE population included: 86.4% of patients were pansensitized to aeroallergens and increased sensitization to unique foods was associated with sensitization to pan-allergens. Increased research into pan-allergen sensitization and cross reactivity to food maybe warranted in highly aeroallergen-pansensitized EoE patients.

Eosinophilic esophagitis: latest insights from diagnosis to therapy

“…In vitro basophil activation which also aims at assessing immediate‐type hypersensitivity has shown very low sensitivity in EoE . Increased levels of food‐specific IgG4 were found in the serum and esophageal tissue of patients with EoE, but appeared not to be correlated with disease activity . Also, measurement of food‐specific IgG4 failed to predict food triggers in EoE .…”

“…Increased levels of food‐specific IgG4 were found in the serum and esophageal tissue of patients with EoE, but appeared not to be correlated with disease activity . Also, measurement of food‐specific IgG4 failed to predict food triggers in EoE . Testing for specific IgG4 in allergic diseases is controversial, as expression of such antibodies to food allergens is common and an increase in titers is usually observed during tolerance induction .…”

“…45 Also, measurement of food-specific IgG4 failed to predict food triggers in EoE. 45 Testing for specific IgG4 in allergic diseases is controversial, as expression of such antibodies to food allergens is common and an increase in titers is usually observed during tolerance induction. 46 Table 1 lists the studies that have examined the predictive value of allergy tests to predict food triggers in children and adults with EoE.…”

Serum autoantibodies against epithelial cell adhesion molecules as disease biomarkers of eosinophilic esophagitis

“…This is particularly notable given that the IgG4 class of antibodies has been recently recognized to be important in EoE. 9,10 It is important to note potential limitations of our study. These include a relatively small number of patients from a single referral centre with post-treatment samples not available from all cases, which could lead to selection bias.…”

“…The detection of an IgG4 to a collagen protein raises the question of this autoantibody in the pathogenesis of EoE, and this should be a future area of investigation. This is particularly notable given that the IgG4 class of antibodies has been recently recognized to be important in EoE …”