Value of microarray allergen assay in the management of eosinophilic oesophagitis

Armentia, Alicia; Martin, S Staege; Barrio, Jesús; Martín, Blanca Garrido; Garcia, JJ; Vega, José M.; Sánchez, A.; Fernández, P.; Corell, Alfredo

doi:10.1016/j.aller.2014.02.006

Cited by 16 publications

(9 citation statements)

References 18 publications

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“…One approach was component resolution diagnostics, which used purified or recombinant individual allergens instead of whole extracts to assess the presence of serum IgE, although this did not improve test characteristics for clinically significant food triggers in EoE. [57][58][59] Moving away from IgE testing, the recent suggestion that IgG4 may be involved in EoE pathogenesis has been supported by the preliminary observations that food-specific IgG4 is elevated in some EoE patients and may correlate with known food triggers. 51,60 This hypothesis has been recently investigated using an approach that combined in vitro measurement of lymphocyte proliferation in response to food allergens and esophageal foodspecific IgG4, which was more accurate than 'classical' allergy tests with histologically proven food triggers used as the 'gold standard'.…”

Section: Determination Of Food Triggers With Allergy Testingmentioning

confidence: 99%

Illuminating Elimination Diets: Controversies Regarding Dietary Treatment of Eosinophilic Esophagitis

2019

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Eosinophilic esophagitis (EoE) is an immune-mediated disease triggered by food antigens for which dietary elimination treatment can induce and sustain histologic remission. Our review aims to describe the state-of-the-art regarding dietary treatment of EoE, highlighting a number of areas of controversy related to dietary therapy in EoE, including novel modalities for determining food triggers, making the empiric dietary elimination process more efficient, issues of crosscontamination and "dosing" of how much food to avoid or add back, costs and effects on qualityof-life, long term efficacy, and the risk of developing immediate IgE-type reactions after initial dietary elimination. Elemental formulas, empiric elimination diets, and targeted allergy testdirected elimination diets are well-described treatments for EoE. Although elemental diets are most efficacious, their clinical use is limited by cost and the palatability of an exclusively liquid diet. While empiric elimination is less effective than elemental formula-based diets, they are more easily implemented and often sustainable. Since the comparative effectiveness of elimination diets with proton pump inhibitors and swallowed topical steroids remains unknown, there are multiple areas to address with future research.

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Section: Determination Of Food Triggers With Allergy Testingmentioning

confidence: 99%

Illuminating Elimination Diets: Controversies Regarding Dietary Treatment of Eosinophilic Esophagitis

2019

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“…Compared with controls, patients with EoE are usually sensitized to several different foods and aeroallergens, as demonstrated not only by skin allergy test results, but also by higher values of serum food-specific IgE. After repeated studies documenting the very limited utility of serum food-specific IgE in the management of EoE patients [25][26][27], the strategy of measuring specific IgE against single allergen molecules by means of microarray assay-based component-resolved diagnosis (CRD) was also recently assessed for its potential to guide specific dietary management of EoE [28,29]. However, a prospective study failed to demonstrate the efficacy of CRDbased dietary treatment in EoE patients.…”

Section: Allergists Step Up To the Plate: Allergy Testing-driven Foodmentioning

confidence: 99%

Eosinophilic Esophagitis: An Evidence-Based Approach to Therapy

González‐Cervera¹,

Aj²

2016

J Investig Allergol Clin Immunol

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In recent years, several randomized controlled trials and meta-analyses have evaluated the efficacy of the various therapeutic options available for treating patients with eosinophilic esophagitis, including dietary modifications, proton pump inhibitors, topical corticosteroids, and endoscopic esophageal dilation. Proton pump inhibitors are currently considered the first-line treatment for eosinophilic esophagitis, achieving histological remission and improvement of symptoms in 50.5% and 60.8% of patients, respectively. The efficacy of topical corticosteroids in eosinophilic esophagitis has been assessed in several trials. Meta-analyses summarizing results indicate that budesonide and fluticasone propionate are significantly superior to placebo, both in decreasing eosinophil densities in the esophageal mucosa and in relieving symptoms. However, owing to differences in drug delivery, viscous budesonide seems to be the best pharmacological therapy for eosinophilic esophagitis. Results for dietary modifications have been mixed depending on the type of diet prescribed. Thus, while exclusive amino acid-based elemental diets are the most effective in inducing histological remission of eosinophilic esophagitis (90.8%), their severe drawbacks limit their implementation in clinical practice. Allergy testing-based food elimination provides a suboptimal remission rate of 45.5%, although this is lower in adults than in children (32.2% vs 47.9%, respectively). In addition, the various available studies are highly heterogeneous. Empirical 6-food elimination diets were shown to be the best diet-based therapy, with a homogeneous remission rate of 72%. Simpler, more convenient empirical schemes have also been evaluated. The aim of this review is to provide an evidence-based overview on the efficacy of the options available for treatment of eosinophilic esophagitis along with a practical management algorithm.

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“…In recent years, climate change has contributed to modifications in pollen release and distribution patterns, and different species are colonizing new areas, modifying the allergenic composition of the environment. In countries with temperate climates such as Spain [4,5] and Italy [6], Pooideae and subtropical grasses coexist in the same areas. In Spain, C dactylon is found throughout the country, while P communis is more frequent in humid areas such as coastal regions and close to rivers [7].…”

Section: Introductionmentioning

confidence: 99%

Relevance of Allergenic Sensitization to Cynodon dactylon and Phragmites communis: Cross-reactivity With Pooideae Grasses

Ma¹,

Moya²,

Cardona³

et al. 2016

J Investig Allergol Clin Immunol

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Background and Objectives: The homologous group of sweet grasses belongs to the Pooideae subfamily, but grass pollen species from other subfamilies can also cause allergy, such as Cynodon dactylon (Chloridoideae) and Phragmites communis (Arundinoideae). C dactylon and P communis have not been included in the sweet grasses homologous group because of their low cross-reactivity with other grasses. The aims of this study were to investigate the profile of sensitization to C dactylon and P communis in patients sensitized to grasses and to analyze cross-reactivity between these 2 species and temperate grasses. Methods: Patients were skin prick tested with a grass mixture (GM). Specific IgE to GM, C dactylon, P communis, Cyn d 1, and Phl p 1 was measured by ImmunoCAP. A pool of sera was used for the immunoblot assays. Cross-reactivity was studied by ELISA and immunoblot inhibition. Results: Thirty patients had sIgE to GM. Twenty-four (80%) had positive results for C dactylon, 27 (90%) for P communis, 22 (73.3%) for nCyn d 1, and 92.9% for rPhl p 1. Bands were detected in the 3 extracts by immunoblot. Inhibition of GM was not observed with C dactylon or P communis by immunoblot or ELISA inhibition. When C dactylon or P communis were used in the solid phase, GM produced almost complete inhibition. Conclusions: Eighty percent of patients sensitized to grasses were also sensitized to C dactylon and 90% were sensitized to P communis. Sensitization to these species seems to be induced by allergens different to those in sweet grasses.

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Value of microarray allergen assay in the management of eosinophilic oesophagitis

Cited by 16 publications

References 18 publications

Illuminating Elimination Diets: Controversies Regarding Dietary Treatment of Eosinophilic Esophagitis

Illuminating Elimination Diets: Controversies Regarding Dietary Treatment of Eosinophilic Esophagitis

Eosinophilic Esophagitis: An Evidence-Based Approach to Therapy

Relevance of Allergenic Sensitization to Cynodon dactylon and Phragmites communis: Cross-reactivity With Pooideae Grasses

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