Seasonal exacerbation of eosinophilic esophagitis histologic activity in adults and children implicates role of aeroallergens

Reed, Craig C.; Iglesia, Edward G.A.; Commins, Scott P.; Dellon, Evan S.

doi:10.1016/j.anai.2018.12.013

Cited by 60 publications

(39 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While incompletely understood, the pathogenesis involves a Th2 type cascade triggered by food or environmental allergens, likely in the setting of an esophageal epithelial barrier defect [3,4]. The rapid rise in incidence and prevalence of EoE over the past 2-3 decades suggests environmental rather than genetic changes [5,6], and a number of investigations have explored potential environmental risk factors including population density, climate, and season or aeroallergens [7][8][9][10]. More recently, there has been a focus on early life risk factors [11,12].…”

Section: Introductionmentioning

confidence: 99%

Lack of association of the esophageal microbiome in adults with eosinophilic esophagitis compared with non-EoE controls

Johnson

Dellon

McCoy

et al. 2021

JGLD

View full text Add to dashboard Cite

Background and Aims: Changes in the esophageal microbiome have been reported in children with eosinophilic esophagitis (EoE), but few data exist for adults. We aimed to determine whether the esophageal microbiome differs in adults with and without EoE. Methods: In a prospective cohort study, adults undergoing outpatient endoscopy were enrolled as incident EoE cases or non-EoE controls. Clinical, endoscopic, and histologic data were collected. An esophageal biopsy was utilized for microbiome analysis. Bacterial DNA was extracted and the V3-V4 region of the 16S rRNA gene was amplified and sequenced. Analyses were performed comparing microbiome features for cases and controls, and within cases for disease features, with correction for multiple hypothesis testing. Results: A total of 24 incident EoE cases (mean age 40 years; 63% male; 100% white; 97 eos/hpf) and 25 controls (mean age 48, 36% male; 76% white; 1 eos/hpf) were analyzed. Principal coordinate analysis ordination failed to distinguish cases from controls. There were no microbiome differences within EoE cases based on clinical phenotype, presence of atopy, or endoscopic features. Use of proton pump inhibitors (PPIs), however, was significantly associated with 5 taxa including SR1 at the phylum level and Burkholderia at the genus level. Conclusions: There were no significant differences in the esophageal microbiome between newly diagnosed EoE cases and non-EoE controls in adults, or within EoE cases based on clinical features. However, given the strong rationale for the esophageal microbiome in EoE pathogenesis, future studies should explicitly consider the presence of PPIs as a confounding feature.

show abstract

Section: Introductionmentioning

confidence: 99%

Lack of association of the esophageal microbiome in adults with eosinophilic esophagitis compared with non-EoE controls

Johnson

Dellon

McCoy

et al. 2021

JGLD

View full text Add to dashboard Cite

show abstract

“…Despite the fact that studies have already shown seasonal exacerbations of EoE in children with comorbid allergic rhinitis ( 40 ), only the study of Molina-infante examined the effect of the pollen season on the efficacy of a diet and showed no negative influence on the remission rates ( 17 ). Importantly, only a handful of patients were diagnosed with OAS of which all were already avoiding the cross-reactive foods before enrollment.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Perspective on the Dietary Therapies for Pediatric Eosinophilic Esophagitis: The Gap Between Research and Daily Practice

et al. 2021

View full text Add to dashboard Cite

Pediatric eosinophilic esophagitis (ped-EoE) is an immune-mediated pathology affecting 34 per 100.000 children. It is characterized by an esophageal inflammation caused by an immune response towards food antigens that come into contact with the esophageal lining. Depending on the age of the child, symptoms can vary from abdominal pain, vomiting and failure to thrive to dysphagia and food impaction. The diagnosis of this chronic disease is based on the symptoms of esophageal dysfunction combined with an infiltration of more than 15 eosinophils per high-power field and the exclusion of secondary causes. The treatment modalities include the 3Ds: Drugs, allergen avoidance by Diet and/or esophageal Dilation. In this review we focused on the efficacy of dietary approaches in ped-EoE, which currently include the elemental diet (amino acid-based diet), the empiric elimination diet and the allergy test-directed elimination diet. Although several reviews have summarized these dietary approaches, a lack of consistency between and within the elimination diets hampers its clinical use and differences in subsequent reintroduction phases present a barrier for dietary advice in daily clinical practice. We therefore conducted an analysis driven from a clinician’s perspective on these dietary therapies in the management of ped-EoE, whereby we examined whether these variations within dietary approaches, yet considered to be similar, could result in significant differences in dietary counseling.

show abstract

“…24,25 Growing evidence suggests that esophageal inflammation is impacted by seasonal aeroallergens in patients with comorbid EoE and allergic rhinitis, leading to increased esophageal mucosal inflammation. 26,27 However, a significant proportion of patients with EoE do not demonstrate signs of allergy, suggesting that this may be a different phenotype. 28 Indeed, other non-atopic diseases, such as inflammatory bowel disease, 29 connective tissue disorders, 30 autism, 31 attention deficit hyperactivity disorder, 31 and additional monogenic disorders, 31,32 have been shown to be associated with EoE.…”

Section: Atopic Vs Non-atopic Phenotypementioning

confidence: 99%

Phenotypes and endotypes in eosinophilic esophagitis

Ruffner

Cianferoni

2020

Annals of Allergy, Asthma & Immunology

View full text Add to dashboard Cite

Eosinophilic esophagitis (EoE) shares many features with other atopic diseases such as asthma, including heterogeneity in its presentation, natural history, and response to treatment. Clinical and molecular evidence suggests that different eosinophilic esophagitis patient phenotypes and endotypes exist. Phenotypic variations in EoE include the age of onset, degree of atopic comorbidity, response to different forms of therapy, and disease severity, among others. Biomarkers that may provide insight into the mechanisms of EoE for defining endotypes include the presence or absence of systemic Th2 inflammation, genetic risk factors, and histologic findings.

show abstract

Seasonal exacerbation of eosinophilic esophagitis histologic activity in adults and children implicates role of aeroallergens

Cited by 60 publications

References 39 publications

Lack of association of the esophageal microbiome in adults with eosinophilic esophagitis compared with non-EoE controls

Lack of association of the esophageal microbiome in adults with eosinophilic esophagitis compared with non-EoE controls

A Clinical Perspective on the Dietary Therapies for Pediatric Eosinophilic Esophagitis: The Gap Between Research and Daily Practice

Phenotypes and endotypes in eosinophilic esophagitis

Contact Info

Product

Resources

About