Allergy Tests for the Diagnosis of Culprit Allergens in Eosinophilic Esophagitis: A Systematic Review

Pitsios, Constantinos; Vassilopoulou, Εmilia; Pantavou, Katerina; Terreehorst, Ingrid; Nowak-Wegzryn, Anna; Cianferoni, Antonella; Tsigkrelis, Georgios Panagiotis; Papachristodoulou, Maria; Bonovas, Stefanos; Nikolopoulos, Georgios K.

doi:10.2139/ssrn.4042682

Cited by 4 publications

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“…Despite there was considerable heterogeneity between studies, attributable to varying methods of allergy testing, a meta-analysis that combined the results of all studies using allergy-based testing to identify food triggers in patients with EoE provided a summary estimate for effectiveness in achieving histological remission of 32.2% in adults and 47.9% in children (23,24). Also, according to a systematic review of 16 studies published between 2002 and 2020, the positive predictive value (PPV) of the SPT+APT combination was 67.1%, with 65-88.3% of patients presenting symptom improvement after following a SPT+APT-based elimination diet (25). The combination of SPT+APT+sIgE was studied only by Dalby et al (26) stating symptoms' improvement in 67% of patients.…”

Section: F O R P U B L I C a T I O Nmentioning

confidence: 99%

“…Considering these results and once difficulties in patients' compliance with empirical avoidance diets are real and frequently observed in our clinical practice, we think that allergy tests, SPT and APT, may continue to be considered, especially in children, as a complement to first-line pharmacological therapy (swallowed corticosteroids and/or PPI) and not as a replacement for it (10,24). Additionally, SPT are particularly important to confirm or exclude the suspected diagnosis of concomitant IgE-mediated food allergy (25).…”

Section: F O R P U B L I C a T I O Nmentioning

confidence: 99%

“…A meta-analysis by Arias et al, reports that the effectiveness of an amino-acid-based elemental diet is approximately 90% in both children and adults, and the 6-FED show effectiveness for 72.1% of cases, while the allergy-test-directed elimination has shown efficacy in only 45.5% of the cases. However, in a recently published systematic review by Dalby et al, formerly stated, allergy-test-driven elimination diets are effective in 66-88.3% of the cases, similarly to empirical diets (25,34).…”

Section: F O R P U B L I C a T I O Nmentioning

confidence: 99%

“…As efficacy of allergy-test-driven elimination diets do not seem to be superior to empiric FED based on most involved foods or food groups (e.g., two-, four-, and six-food diets), we assume that the decision any of these options, or alternatively a 4-or 2-FED (corresponding respectively to 54%-64% and 43% response rates), are valid and should be individualized and selected according to patient's diet adherence and lifestyle (24,25).…”

Section: F O R P U B L I C a T I O Nmentioning

confidence: 99%

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A real-world characterization of a cohort with eosinophilic esophagitis: looking for severity biomarkers

Caldeira¹,

Limão²,

Brás³

et al. 2024

Eur Ann Allergy Clin Immunol

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Background: Eosinophilic esophagitis (EoE) is an immune-mediated chronic esophageal disease, with frequent association with atopy. A validated non/minimally invasive biomarker of disease severity has not been identified. Objective: We aimed to determine if sensitization to airborne and food allergens correlates with disease severity, and to evaluate the association between clinical and laboratory characteristics with the severity of EoE.Methods: Retrospective study of EoE patients observed in a differentiated center, 2009-2021. The association between patients' diagnosis age, disease duration before diagnosis, sensitization to airborne/food allergens, serum total IgE and peripheral blood eosinophil values and severe clinical disease (presence of symptoms with a significant impact on quality of life and/or ≥ 1 hospital admission due to EoE complications, namely severe dysphagia, food impaction or esophageal perforation) and histological severe disease (≥55 eos/hpf and/or microabscesses in esophageal biopsies) was evaluated.Results: 92 patients were observed, 83% male, 87% atopic. There was a mean delay in diagnosis of 4 years (range 0-31). 84% had aeroallergen sensitization and 71% food sensitization. Food impaction and dysphagia were the most frequent symptoms, and severe clinical disease was observed in 55%.Histologically, 37% had severity criteria. Patients with severe clinical disease had a significantly longer mean disease duration before diagnosis than patients without severe clinical disease (79 vs. 15 months; p=0.021). Patients who described food impaction were significantly older at time of diagnosis than those who have never had impaction (18 vs. 9 years; p<0.001).There was no significant association (p<0.05) between sensitization, serum total IgE and peripheral blood eosinophil values and clinical or histological severity. Conclusions:An older age at diagnosis and a longer disease duration before diagnosis appear to be useful for predicting EoE clinical severity. Despite having been demonstrated a high prevalence of allergic disease, the presence of sensitization to airborne and/or food allergens do not seem to be useful for predicting clinical or histological severity.

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Section: F O R P U B L I C a T I O Nmentioning

confidence: 99%

Section: F O R P U B L I C a T I O Nmentioning

confidence: 99%

Section: F O R P U B L I C a T I O Nmentioning

confidence: 99%

Section: F O R P U B L I C a T I O Nmentioning

confidence: 99%

See 2 more Smart Citations

A real-world characterization of a cohort with eosinophilic esophagitis: looking for severity biomarkers

Caldeira¹,

Limão²,

Brás³

et al. 2024

Eur Ann Allergy Clin Immunol

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“…A 3 mois, les patients sous traitement combiné étaient davantage améliorés sur le plan clinique que dans les autres groupes. Il n'y avait pas de différences significatives sur le plan histologique.Différentes études se sont intéressées à l'intérêt des tests allergologiques alimentaires dans le traitement de l'EoE(24,37,(61)(62)(63)(64)(65)(66)(67)(68). L'efficacité du régime (tous allergènes confondus) était évaluée sur l'amélioration clinique et histologique sur les biopsies de réévaluation.…”

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Caractéristiques cliniques, paracliniques et modalités thérapeutiques d’une série de 41 patients suivis pour une œsophagite à éosinophiles

Charansol,

Aubin,

Amiot

et al. 2024

Revue Française d'Allergologie

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A Review of Non-IgE Immune-Mediated Allergic Disorders of the Gastrointestinal Tract

Pundit,

Makkoukdji,

Banegas Carballo

et al. 2024

Gastrointestinal Disorders

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Non-IgE immune-mediated gastrointestinal disorders constitute a heterogeneous group of enigmatic conditions that are on the rise. This category encompasses entities like food protein-induced enterocolitis syndrome (FPIES), food protein-induced allergic proctocolitis (FPIAP), and food protein-induced enteropathy (FPE). These are immune-mediated reactions to certain foods without the involvement of allergen-specific IgE in their pathogenesis. Eosinophilic esophagitis (EoE) is also included in this group, acknowledged for its mixed IgE and non-IgE-mediated characteristics. The diagnostic landscape is fraught with challenges, given the poorly understood nature of these disorders and their propensity to manifest with varying and overlapping clinical presentations, typically emerging in infancy with common potential triggers such as cow’s milk and soy. Presently, confirmatory testing for most of these conditions is limited and invasive, emphasizing the pivotal role of a thorough history and physical examination in reaching a diagnosis. Notably, there are limited guidelines for diagnosis and management for most of these disorders. This article elucidates the key distinctions among these disorders, provides an overview of existing diagnostic and therapeutic approaches, and addresses existing knowledge and research gaps. The considerable impact on the quality of life of non-IgE immune-mediated allergic disorders of the gastrointestinal tract, which can result in debilitating complications such as nutritional deficiencies, mental health disorders, and eating disorders, underscores the urgency for comprehensive exploration and management strategies.

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Allergy Tests for the Diagnosis of Culprit Allergens in Eosinophilic Esophagitis: A Systematic Review

Cited by 4 publications

References 0 publications

A real-world characterization of a cohort with eosinophilic esophagitis: looking for severity biomarkers

A real-world characterization of a cohort with eosinophilic esophagitis: looking for severity biomarkers

Caractéristiques cliniques, paracliniques et modalités thérapeutiques d’une série de 41 patients suivis pour une œsophagite à éosinophiles

A Review of Non-IgE Immune-Mediated Allergic Disorders of the Gastrointestinal Tract

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