Possible eosinophilic esophagitis induced by milk oral immunotherapy

Sánchez‐García, Silvia; Río, Pablo Rodríguez del; Escudero, Carmelo; Martínez-Gómez, Manuel; Ibáñez, María Dolores

doi:10.1016/j.jaci.2011.11.042

Cited by 106 publications

(53 citation statements)

References 9 publications

(2 reference statements)

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“…While some participants withdraw owing to anaphylaxis or other acute reactions, the vast majority of withdrawals are due to chronic abdominal pain. Eosinophilic esophagitis has been documented in some of these cases, and it is not clear how frequently undiagnosed disease may complicate OIT [63,64]. Further studies aimed at minimizing adverse reactions are therefore critically important if these treatments are to be moved forward for use in clinical practice.…”

Section: Immunologic Changes With Oitmentioning

confidence: 99%

Oral Immunotherapy for Food Allergy

Wood

2017

J Investig Allergol Clin Immunol

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Food allergy is a potentially life-threatening condition with no approved therapies apart from avoidance and injectable epinephrine for treatment of acute allergic reactions. Oral immunotherapy (OIT) is an experimental treatment in which patients consume gradually increasing quantities of the food to which they are allergic in an attempt to induce some level of desensitization. While desensitization is possible in most patients, OIT carries significant risks for allergic reactions, and the ability to induce longer-term tolerance has not yet been established. This review focuses on selected studies of OIT for the treatment of common food allergies such as cow's milk, hen's egg, and peanut. Key words: Food allergy. Oral immunotherapy. Cow's milk. Hen's egg. Peanut. Desensitization. Tolerance. Sustained unresponsiveness. Skin prick test (SPT). Immunoglobulin E (IgE). Omalizumab. ResumenLa alergia alimentaria es una condición potencialmente mortal para la que no existen tratamientos aprobados, excepto la evitación y la epinefrina para tratar reacciones alérgicas graves. La inmunoterapia oral (OIT) es un tratamiento experimental en el cual los pacientes ingieren cantidades gradualmente crecientes del alimento al que son alérgicos, con el fin de inducir algún nivel de desensibilización. Si bien la desensibilización es posible en la mayoría de los pacientes, OIT conlleva riesgos importantes de reacciones alérgicas y la capacidad de inducir tolerancia a más largo plazo todavía no ha sido establecida. Este artículo de revisión se centra en una selección de estudios de OIT para el tratamiento de alergias a alimentos comunes, como son la leche de vaca, huevos de gallina y cacahuete. Palabras clave: Alergia alimentaria. Inmunoterapia oral. Leche de vaca. Huevo de gallina. Cacahuete. Desensibilización. Tolerancia. Falta de respuesta sostenida. Prick test. Inmunoglobulina. Omalizumab.

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Section: Immunologic Changes With Oitmentioning

confidence: 99%

Oral Immunotherapy for Food Allergy

Wood

2017

J Investig Allergol Clin Immunol

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“…The majority of these reactions occurred during the dose escalation phase in hospital, but, importantly, reactions to a previously tolerated dose of OIT during home dosing were common [19,20]. Additionally, there have also been reports of eosinophilic gastrointestinal disorders developing in patients with OIT [21]. …”

Section: Clinical Trials Of Oitmentioning

confidence: 99%

Clinical Studies in Oral Allergen-Specific Immunotherapy: Differences among Allergens

Sato¹,

Yanagida

Ogura³

et al. 2014

Int Arch Allergy Immunol

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Oral immunotherapy (OIT) is a significant focus of treatment of food allergy. OIT appears to be effective in inducing desensitization, however, patients receiving OIT frequently developmild/moderate symptoms during the therapy. It has not been clearly established whether the clinical tolerance induced by OIT resembles natural tolerance. According to our data, the efficacy of OIT is different among food antigens, and it is comparatively difficult to achieve the clinical tolerance in milk OIT. Moreover, the definitive evidence of efficacy and safety with long-term therapy is limited. Further studies need to be offered to patients in clinical practice. Recently, novel treatments for food allergy, sublingual and epicutaneous immunotherapy, and combination treatment with an anti-IgE monoclonal antibody (omalizumab), have been examined in some studies. OIT combined with omalizumab increased the threshold doses of food without adverse reactions and may be of benefit in food allergy treatment. More studies are needed to demonstrate long-term safety and treatment benefits in a larger patient cohort.

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“…These patients recovered after a milk-free diet. One of the patients had undergone endoscopy before starting OIT, and no sign of inflammation or eosinophilic infiltration had been observed [55] .…”

Section: Oit and Eosinophilic Esophagitismentioning

confidence: 99%

Oral and Sublingual Immunotherapy: Potential Causes for Eosinophilic Gastrointestinal Disorders?

Babaie

Mesdaghi

Nishino

et al. 2017

Int Arch Allergy Immunol

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Food allergy is a common health problem worldwide, with increasing prevalence during recent decades. The only approved treatments for food allergy are food avoidance and administration of emergency medications in case of accidental exposure, which negatively affects patients' quality of life, so new treatments are highly desirable. Different food immunotherapy modalities have recently been used, with variable success rates in the induction of desensitization and tolerance, and different numbers and types of adverse reactions. Adverse reactions, especially intolerable gastrointestinal symptoms, are the most important causes of immunotherapy withdrawal. Eosinophilic esophagitis has been reported as a complication of milk, egg, and peanut oral immunotherapies and sublingual immunotherapy for respiratory allergies, but not for food allergies. Eosinophilic gastritis and eosinophilic colitis also rarely happened following egg and milk oral immunotherapies. The patients undergoing oral and sublingual immunotherapies should be closely followed up for a long time, and those with gastrointestinal symptoms should be evaluated by endoscopy of the gastrointestinal tract. These complications are usually reversible after early diagnosis and stopping the immunotherapy protocol.

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Possible eosinophilic esophagitis induced by milk oral immunotherapy

Cited by 106 publications

References 9 publications

Oral Immunotherapy for Food Allergy

Oral Immunotherapy for Food Allergy

Clinical Studies in Oral Allergen-Specific Immunotherapy: Differences among Allergens

Oral and Sublingual Immunotherapy: Potential Causes for Eosinophilic Gastrointestinal Disorders?

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