Clinical and immunopathologic effects of swallowed fluticasone for eosinophilic esophagitis

Gastrointestinal Eosinophilia

“…[22,23] Even though the term "primary" is used here, evidence is accumulating supporting the concept that EGID arises secondary to the interplay of genetic and environmental factors. Notably, a large percentage (∼10%) of patients suffering from EGID have an immediate family member with EGID.…”

“…Notably, a large percentage (∼10%) of patients suffering from EGID have an immediate family member with EGID. [22] Additionally, several lines of evidence support an allergic etiology including the finding that ∼75% of patients with EGID are atopic, [21,[24][25][26][27][28][29][30] that the severity of disease can sometimes be reversed by institution of an allergen-free diet, [29][30][31] and the common finding of mast cell degranulation in tissue specimens. [32,33] Importantly, our recent models of EGID support a potential allergic etiology for these disorders.…”

“…[22] A diagnostic evaluation for EGID should be performed on all patients with these refractory problems, especially in individuals with a strong history of allergic diseases, peripheral blood eosinophilia, and/or a family history of EGID. Depending upon the intestinal segment involved, the frequency of specific symptoms varies (e.g.…”

“…Indeed, patients with the atopic variant of EGID have evidence of IgE sensitization to a mean of 14 different food groups. [22] A preliminary study has suggested a value for delayed cutaneous hypersensitivity testing (skin patch testing) for specific food antigens, in further identifying allergic variants of EE. [30] The diagnosis of EGID is dependent upon the microscopic evaluation of endoscopic biopsy samples, with careful attention to the quantity, location, and characteristics of the eosinophilic inflammation.…”

“…Based on these criteria, patients often suffer from symptoms for an extended period of time (mean of 4 years) before a bona fide diagnosis of EGID is established. [22] …”