Prevalence of atopic disease in patients with eosinophilic esophagitis

Benninger, Michael S.; Strohl, Madeleine P.; Holy, Chantal E.; Hanick, Andrea; Bryson, Paul C.

doi:10.1002/alr.21968

Cited by 44 publications

(21 citation statements)

References 47 publications

(56 reference statements)

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“…[14][15][16] EoE is considered to be a type 2 immune disease that often co-occurs with atopic diseases, including atopic dermatitis (AD), asthma, and food allergies. [17][18][19][20] As such, EoE is characterized by increased levels of the type 2 cytokines, which are critical for promoting cellular responses in patients with EoE. Early mouse studies revealed IL-5 as an important contributing factor for eosinophilic development and tissue infiltration and for remodeling.…”

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confidence: 99%

Epithelial origin of eosinophilic esophagitis

Rochman

Azouz

Rothenberg

2018

Journal of Allergy and Clinical Immunology

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Eosinophilic esophagitis (EoE) is a chronic, allergen-driven inflammatory disease of the esophagus characterized predominantly by eosinophilic inflammation, leading to esophageal dysfunction. Converging data have placed the esophageal epithelium at the center of disease pathogenesis. In particular, the main EoE disease susceptibility loci at 2p23 and 5p22 encode for gene products that are produced by the esophageal epithelium: the intracellular protease calpain 14 and thymic stromal lymphopoietin, respectively. Furthermore, genetic and functional data establish a primary role for impaired epithelial barrier function in disease susceptibility and pathoetiology. Additionally, the EoE transcriptome, a set of genes dysregulated in the esophagi of patients with EoE, is enriched in genes that encode for proteins involved in esophageal epithelial cell differentiation. This transcriptome has a high proportion of esophagus-specific epithelial genes that are notable for the unexpected enrichment in genes encoding for proteases and protease inhibitors, as well as in IL-1 family genes, demonstrating a previously unappreciated role for innate immunity responses in the esophagus under homeostatic conditions. Among these pathways, basal production of the serine protease inhibitor, Kazal-type 7 (SPINK7) has been demonstrated to be part of the normal differentiation program of esophageal epithelium. Profound lost expression of SPINK7 occurs in patients with EoE and is sufficient for unleashing increased proteolytic activity (including urokinase plasminogen activator), impaired barrier function, and production of large quantities of proinflammatory and proallergic cytokines, including thymic stromal lymphopoietin. Collectively, we put forth a model in which the esophagus is normally equipped as an anti-inflammatory sensing organ and that defects in this pathway, mediated by epithelial protease/protease inhibitor imbalances, unleash inflammatory responses resulting in disorders, such as EoE.

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confidence: 99%

Epithelial origin of eosinophilic esophagitis

Rochman

Azouz

Rothenberg

2018

Journal of Allergy and Clinical Immunology

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“…So whether the underlying mechanism of CU and diarrhea involves more than one type of immune response (e.g., IgG mediated) needs further investigation. Besides, AR was usually associated with upper GI diseases, like oral allergy syndrome triggered by pollen, food, or eosinophilic esophagitis [30,31].…”

Section: Discussionmentioning

confidence: 99%

Association between Allergic Diseases and Irritable Bowel Syndrome: A Retrospective Study

Fang

Zhang

Lü

et al. 2018

Int Arch Allergy Immunol

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Background: The relationship between allergic disease and irritable bowel syndrome (IBS) is poorly understood. We aimed to investigate the potential association as well as the underlying immunological mechanisms. Methods: A retrospective case-control study of 108 atopic patients from among outpatients in an allergy clinic (allergic rhinitis [AR], n = 49; chronic urticaria [CU], n = 59) and 74 controls from among ward companions was conducted from November 2016 to March 2017. The detection rates and related gastrointestinal (GI) symptoms of IBS, as well as immunological indices, were calculated. Results: CU patients had a trend of increase in the detection of IBS compared to controls (OR = 4.846; 95% CI 0.967–24.279, p = 0.077). Loose stools (OR = 2.406; 95% CI 1.075–5.386, p < 0.05) and viscous stools (OR = 2.665; 95% CI 1.250–5.682, p < 0.05) were more common in CU patients. Atopic patients positive for serum total immunoglobulin E (IgE) (OR = 3.379; 95% CI 1.088–10.498, p < 0.05) or house dust mite (HDM)-specific IgE (OR = 3.640; 95% CI 1.228–10.790, p < 0.05) were more likely to have abdominal bloating. Besides, a positive association between levels of total IgE and severity of abdominal bloating was observed (p < 0.05). An HDM-specific IgE-positive reaction was independently associated with abdominal bloating in atopic patients (p < 0.05). Conclusions: Allergic disease has a clear clinical association with IBS with more frequent and severe symptoms of IBS. CU patients have a tendency to suffer from IBS, usually with diarrhea. Serum total IgE and HDM-specific IgE are positively correlated with GI symptoms in atopic patients.

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“…In general, eosinophils have been hypothesized to move to the esophagus in response to various ingested and/or inhaled allergens, thereby associating EoE with allergy-induced diseases. As a result of that, a high prevalence of atopic diseases (e.g., asthma, allergic rhinitis, and atopic dermatitis) and sensitization to food and environment allergens is seen in pediatric and adult EoE populations [9, 64].…”

Section: Etiological Factorsmentioning

confidence: 99%

An Update on Eosinophilic Esophagitis: Etiological Factors, Coexisting Diseases, and Complications

Khan

Guo

et al. 2020

Digestion

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Background: Eosinophilic esophagitis (EoE) is an immune-mediated clinicopathological condition characterized by esophageal infiltration with eosinophils resulting in chronic inflammation and stricture. Summary: The recent increase in the incidence of EoE and the characteristic presentation of symptoms with difficulty swallowing and food bolus impaction has raised key concerns of clinicians as well as researchers. EoE often presents with dysphagia, food impaction, nausea, regurgitation or vomiting, and decreased appetite. It is more common in males, affecting both adults and children. The causative manner of this condition is complex and multifactorial. Throughout recent years, researchers have made a significant contribution to understanding the pathogenesis of EoE, genetic background, natural history, work on allergy, and standardization in the evaluation of disease activity. There is relatively high prevalence of EoE among the population, emphasizing the importance of this disease. Key messages: Esophageal involvement with eosinophils may be manifested as isolated or with coexisting conditions and should be taken into consideration in the differential diagnosis. This study aimed to provide gastroenterologists with novel insights into the evaluation of esophageal involvement with eosinophils and to pay special attention to the etiological factors, coexisting clinical diseases, and complications.

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Prevalence of atopic disease in patients with eosinophilic esophagitis

Abstract: The diagnosis of EoE is associated with the diagnoses of asthma, AR, AD, and food allergies. The high prevalence of these conditions in EoE patients further strengthens the hypothesis of a common pathogenesis.

Cited by 44 publications

References 47 publications

Epithelial origin of eosinophilic esophagitis

Epithelial origin of eosinophilic esophagitis

Association between Allergic Diseases and Irritable Bowel Syndrome: A Retrospective Study

An Update on Eosinophilic Esophagitis: Etiological Factors, Coexisting Diseases, and Complications

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