Primary eosinophilic gastrointestinal disorders in children who have received food oral immunotherapy

Echeverría-Zudaire, L.; Fernández‐Fernández, Sonia; Rayo-Fernández, A.; Muñóz-Archidona, C.; Checa-Rodriguez, R.

doi:10.1016/j.aller.2016.05.002

Cited by 43 publications

(42 citation statements)

References 26 publications

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“…Both Escudero et al and Burcks reported similar data, with fewer reactions and no severe reactions in the maintenance phase; nevertheless, Vazquez‐Ortiz et al observed the same frequency of reactions during the induction and maintenance phases with the same maintenance dose, but they require epinephrine treatment only during induction phase. Finally, unlike other studies, we did not observe development of esophagitis throughout the assay, despite the prolonged period of immunotherapy with high doses of the allergen, but esophagitis symptoms were an exclusion criteria in our study and other studies reporting these findings did not evaluate these symptoms at the start of the OIT.…”

Section: Discussionmentioning

confidence: 99%

Egg OIT in clinical practice (SEICAP II): Maintenance patterns and desensitization state after normalizing the diet

Martín-Muñoz

Lebrero

Zapatero

et al. 2018

Pediatric Allergy Immunology

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Background It is unknown which are the most suitable maintenance pattern and egg consumption to maintain the desensitization state after ending the oral immunotherapy (OIT). This multicenter, randomized, controlled trial compared two OIT maintenance patterns with pasteurized egg white (PEW), evaluating the egg consumption effect on the desensitization state after ending the OIT. Methods One hundred and one children with confirmed egg allergy were randomized: 25 to an egg‐free diet (CG) and 76 to an OIT year with PEW and two maintenance patterns, 38 patients to daily 3.3 g proteins (AG) and 38 to every two days (BG). PEW challenge (DBPCFC), adverse reactions, and immune markers were assessed at baseline, at the end of the OIT, and at 6 and 12 months later on ad libitum egg consumption (T0, T12, T18, and T24). A questionnaire evaluated the egg consumption at T18. Results At T12, 64 of 76 (84.21%) OIT patients had reached total desensitization (32 AG and 32 BG) vs 4 of 25 (16.00%) CG who passed the PEW DBPCFC. Thirty (93.75%) AG vs 25 (78.12%) BG patients completed an OIT year. At T18, 27 of 29 (93.1%) AG vs 20 of 24 (83.3%) BG passed the PEW DBPCFC, 96% consuming at least two egg servings/week. At T24, 97.43% OIT patients passed the challenge. Most patients had adverse reactions, more frequent in the BG patients; frequency and severity of reactions decreased through the study. PEW skin prick test wheal and sIgE antibody serum levels similarly decreased in AG or BG, but AG patients had greater increase in PEW sIgG4 (P < 0.05). Conclusions Daily OIT maintenance achieves better adherence, effectiveness, and safety. Two egg servings/week ensure maintained desensitization after the end of an OIT year.

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Section: Discussionmentioning

confidence: 99%

Egg OIT in clinical practice (SEICAP II): Maintenance patterns and desensitization state after normalizing the diet

Martín-Muñoz

Lebrero

Zapatero

et al. 2018

Pediatric Allergy Immunology

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“…Furthermore, those with IgE‐mediated food allergy had significantly more dysphagia, poor appetite, cough and gagging at presentation than children without IgE‐mediated food allergy and heartburn was a much more common feature if IgE allergy was not present . There is also emerging evidence that in a small cohort of children who have undergone oral immunotherapy (OIT) for IgE‐mediated food allergies or grass pollen allergies, that they develop EGID as a side effect of the OIT …”

Section: Overlap Between Non‐ige‐mediated and Ige‐mediated Allergies mentioning

confidence: 99%

Non‐IgE‐mediated gastrointestinal allergies—Do they have a place in a new model of the Allergic March

Fox

Lozinsky

Michaelis

et al. 2019

Pediatric Allergy Immunology

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The rise in food allergy has been described as the “second wave” of the allergy epidemic, with some developed countries reporting a prevalence of 10% of challenge‐proven food allergies. Recognition of the Allergic March has played a crucial role in identifying causality in allergic conditions, linking atopic dermatitis to food allergy and food allergy to other atopic disorders, thereby highlighting opportunities in prevention and the importance of early intervention. This publication will establish the value of weaving the less well‐understood, non‐IgE‐mediated food allergy into the Allergic March and mapping its progression through childhood and its associated co‐morbidities. The proposed non‐IgE‐mediated Allergic March highlights the concomitant presentation of gastrointestinal symptoms and atopic dermatitis as early presenting symptoms in confirmed non‐IgE‐mediated allergies and the later development of atopic co‐morbidities, including asthma and allergic rhinitis, similar to the IgE‐mediated Allergic March. This publication highlights recent observations of a link between non‐IgE‐mediated food allergy in early childhood and functional gastrointestinal disorders in later life and also the reported occurrence of extra‐intestinal manifestations at later ages. Although significant limitations exist in regard to the proposed evolution of the Allergic March model, the authors hope that this publication will influence the management of non‐IgE‐mediated gastrointestinal allergies and inform future research and interventions.

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“…Blood tests showed a remarkable increase in peripheral blood eosinophil count, and endoscopic biopsy of the upper gastrointestinal tract revealed diffuse eosinophilic infiltration from the esophagus to the duodenum, confirming the diagnosis of EG with concurrent involvement of the esophagus [76] . A recent article has also reported 2 cases of EG following milk OIT [59] .…”

Section: Oit and Eg And Eosinophilic Colitismentioning

confidence: 99%

“…EC involves the large intestine alone [75] . Although there have been multiple case reports of EoE during or following OIT, little has been reported of EG, and as far as we know, no reports of EC during or following OIT exist [59,69,76] .…”

Section: Oit and Eg And Eosinophilic Colitismentioning

confidence: 99%

“…OIT was discontinued in both patients with EG and 1 of the patients with EoE, which was followed by histological remission. Among 5 other patients, 3 achieved histological remission by proton pump inhibitors alone or in combination with swallowed fluticasone, 1 remained histologically active, and 1 refused follow-up endoscopy [59] . Table 1 summarizes the characteristics of all published cases of EoE and EG following OIT.…”

Section: Oit and Eosinophilic Esophagitismentioning

confidence: 99%

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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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Primary eosinophilic gastrointestinal disorders in children who have received food oral immunotherapy

Cited by 43 publications

References 26 publications

Egg OIT in clinical practice (SEICAP II): Maintenance patterns and desensitization state after normalizing the diet

Egg OIT in clinical practice (SEICAP II): Maintenance patterns and desensitization state after normalizing the diet

Non‐IgE‐mediated gastrointestinal allergies—Do they have a place in a new model of the Allergic March

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

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