Eosinophil infiltration of the oesophageal mucosa in patients with pollen allergy during the season

Abstract

Thirty-eight symptomatic patients (allergic rhinitis (AR) with or without asthma) who had sensitization to grass pollen were included in the study during the pollen season. Controls were composed of 25 healthy non-atopics and 24 patients diagnosed as having gastro-oesophageal reflux disease. Reflux was excluded in allergic and non-atopic groups, whereas the presence of allergy was eliminated in control groups. Gastrointestinal endoscopy was performed in all participants, and biopsy specimens were taken from both the proximal and the distal oesophagus to evaluate eosinophil accumulation. At the same time, blood eosinophil numbers were counted. Results Oesophageal eosinophil accumulation was found in 10 allergic patients (26%) and in five patients (21%) with gastro-oesophageal reflux disease but none of the healthy controls had eosinophils (0%) (P<0.05). Blood eosinophils were higher in these 10 patients than the rest of the 28 patients without infiltration. In this group, blood eosinophils were also correlated with the number of accumulated eosinophils in the oesophagus (P<0.001). There was more intense eosinophil infiltration at the distal part of the oesophagus in the reflux group when compared with the allergic group (mean 7.6+/-5.6 vs. 3.2+/-3.7). Nevertheless, eosinophils were found to be concentrated (mean 5.5+/-7.3) in the proximal oesophagus of allergic patients, although it was 1.7+/-1.5 in reflux patients (P>0.05). Conclusion Our results showed that eosinophil infiltration might be observed in oesophageal tissue of patients with respiratory tract allergy during the symptomatic period. This finding may possibly reflect the systemic and common mucosal aspects of allergic inflammation.

Seasonal exacerbation of esophageal eosinophilia in children with eosinophilic esophagitis and allergic rhinitis

“…5 Further evidence for seasonality of EoE symptoms and esophageal eosinophilia has been described in other studies. Onbasi et al 6 found that 26% of patients with allergic rhinitis without GERD had esophageal eosinophilia at biopsy examination during a time of active allergy symptoms. Wang et al 7 found that significantly fewer cases of EoE were diagnosed in children during the winter season compared with spring, summer, and fall.…”

Eosinophilic Esophagitis

“…Another explanation may be related to the systemic immune response of allergens. Once a susceptible patient is exposed to an allergen, the bone marrow increases eosinophil production with subsequent migration of eosinophils to the esophagus in patients with EoE, similar to the migration of eosinophils to the airways in asthmatics [27,28].…”

A Role for Pathogenesis-Related Proteins in Poly-Sensitized Allergic Patients with Eosinophilic Esophagitis: Clinical and Endoscopic Features

“…The patients with EoE we studied had a clinical presentation including the symptoms, such as heartburn, food impaction, and dyspepsia, that were validated by the Mayo dysphagia questionnaire [14]. Both inhalant and food allergens seem to play a role in the pathophysiology of EoE [18], as demonstrated for aeroallergens in experimental animal models, while in humans it was suggested by the fact that eosinophil infiltration may be observed in esophageal tissue of patients with respiratory allergy during the symptomatic period [19,20]. The important role of food allergens in EoE was shown by an improvement of symptoms and resolution of histological abnormalities after specific elimination diets [21][22][23].…”