Eosinophilic esophagitis is characterized by a non-IgE-mediated food hypersensitivity

Abstract

Eosinophilic esophagitis (EoE) is a chronic disease characterized clinically by symptoms of esophageal dysfunction and histologically by eosinophil-predominant inflammation. EoE is frequently associated with concomitant atopic diseases and immunoglobulin E (IgE) sensitization to food allergens in children as well as to aeroallergens and cross-reactive plant allergen components in adults. Patients with EoE respond well to elemental and empirical food elimination diets. Recent research has, however, indicated that the pathogenesis of EoE is distinct from IgE-mediated food allergy. In this review, we discuss the individual roles of epithelial barrier defects, dysregulated innate and adaptive immune responses, and of microbiota in the pathogenesis of EoE. Although food has been recognized as a trigger factor of EoE, the mechanism by which it initiates or facilitates eosinophilic inflammation appears to be largely independent of IgE and needs to be further investigated. Understanding the pathogenic role of food in EoE is a prerequisite for the development of specific diagnostic tools and targeted therapeutic procedures.Abbreviations ACD, allergic contact dermatitis; AD, atopic dermatitis; APT, atopy patch test; DHR, drug hypersensitivity reactions; EoE, eosinophilic esophagitis; FPIES, food protein-induced enterocolitis; GERD, gastroesophageal reflux disease; GI, gastrointestinal; IBD, inflammatory bowel disease; Ig, immunoglobulin; OAS, oral allergy syndrome; PPI-REE, proton pump inhibitor-responsive esophageal eosinophilia; SFED, six-food elimination diet; SPT, skin prick test; TCR, T-cell receptor; TNF, tumor necrosis factor.Allergy 71 (2016) 611-620

Letter: dietary therapy in eosinophilic oesophagitis – do not test, just eliminate and reintroduce the most common food triggers

“…4 EoE is a unique form of food allergy, distinct from IgEmediated food allergy. 5 The pathophysiology of EoE is complex, likely dependent on a balance between a predominant IgG4-, and a less predominant IgE-, associated disease. 6 EoE is a global disease, with the same main triggering foods (milk, wheat, eggs) prospectively identified in either paediatric or adult patients from developed countries, either in the Northern or Southern Hemisphere (Table 1).…”

Diagnosis and treatment of eosinophilic esophagitis in clinical practice

“…This reaction occurs primarily via non-IgE mediated hypersensitivity (delayed hypersensitivity), with a partial participation of IgE-mediated hypersensitivity (immediate hypersensitivity) [44][45][46]. Acute EE associated with an immediate food hypersensitivity is reportedly present, but it is an uncommon condition [47,48].…”

La mystérieuse œsophagite à éosinophiles garde encore quelques secrets

“…Si on considère enfinq ue les éosinophiles ne sont pas nécessaires sensu stricto au développementd es ignes cliniques similaires à l'EoE chez des sujets génétiquement susceptibles comme nous l'avons vu plus haut [16], on s'aperçoit que l'EoE at rès vraisemblablement des mécanismes pathogéniques bien différents des maladies allergiques classiques. Une publication récente, qui rassemble certains des plus grands experts de l'EoE des deux côtésd e l'Atlantique, présente désormais l'EoE comme une hypersensibilité alimentaire non-dépendante des IgE, en soulignant son origine immuno-antigénique mais en la distinguant des allergies alimentaires [9]. [29,30,31].…”

“…Une nouvelle entité ac ependant été décrite ces dernières années, entraînant une certaine confusion :l ' é osinophilie oesophagienne répondant aux IPP. Cette affection est décrite chez des patients avec en généralu ne prédisposition atopique, comme l'EoE mais pas le RGO,e tr é pondc liniquement et histologiquement aux IPP,c omme le RGO mais pas l'EoE [8,9,10]. La confusion est donc facile, et peut expliquer le fait qu'on lise souvent, de manière regrettable, que les IPP peuvent traiter l'EoE.…”