Induction of Eosinophilic Esophagitis by Sublingual Pollen Immunotherapy

Miehlke, Stephan; Alpan, Oral; Schröder, S.; Straumann, Alex

doi:10.1159/000355161

Cited by 118 publications

(62 citation statements)

References 13 publications

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“…This was illustrated by one subject that developed acute eosinophilic esophagitis after exposure to sublingual immunotherapy that included typical airborne antigens such as hazelnut, birch and alder. This esophageal response resolved clinically and endoscopically after the immunotherapy was discontinued [48] . There is also experimental evidence in wild mice that repeated nasal inoculation with allergens such Aspergillus fumigatus triggers an eosinophilic infiltration of the esophagus.…”

Section: Pathogenesismentioning

confidence: 92%

Eosinophilic esophagitis: New insights in pathogenesis and therapy

Guarino

Cicala

Behar

2016

WJGPT

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Eosinophilic esophagitis (EoE) is a clinico-pathological entity with esophageal symptoms and dense esophageal eosinophilic infiltration throughout the esophagus that may persist despite treatment with proton pump inhibitors. This eosinophilic infiltration is usually absent in the stomach, small intestine and colon, although there are a number of reports of patients with a multiorgan involvement. EoE is associated with abnormalities involving TH2-dependent immunity, with multiple environmental factors strongly contributing to disease expression. The layer of the esophagus affected by the eosinophilic infiltration causes the specific symptoms. Esophageal involvement results mostly in dysphagia for solids that can be severe enough to cause recurrent esophageal obstruction with typical endoscopic features suggesting esophageal remodeling and pathological changes of eosinophilic infiltration of the mucosa, sub-epithelial fibrosis and muscle hypertrophy. This disease is frequently associated with other allergic conditions such as allergic asthma, allergic dermatitis and eosinophilia. The treatment of patients with EoE depends on the severity of the symptoms and of the inflammatory process as well as to their response to a gradual step-up treatment. The first line of treatment consists of steroid containing local inhalers. If unresponsive they are then treated with oral steroids. Intravenous interleukin blockers seem to have a consistent positive therapeutic effect. Core tip: Eosinophilic esophagitis is a clinico-pathological entity characterized by esophageal symptoms and dense esophageal eosinophilic infiltration throughout the esophagus. Our manuscript provides a deep description of the disease showing that many efforts have been made in the last decades in understanding REVIEWSubmit a

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Section: Pathogenesismentioning

confidence: 92%

Eosinophilic esophagitis: New insights in pathogenesis and therapy

Guarino

Cicala

Behar

2016

WJGPT

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“…Since then, it has been progressively applied as a treatment for food and pollen allergies in adults and children [97] . EoE has been repeatedly reported as an adverse reaction following OIT with milk, egg, and peanut, but it has also been reported to happen following SLIT in some cases.…”

Section: Slit and Eoementioning

confidence: 99%

“…For the first time, Miehlke et al [97] presented a 44-year-old woman, who demonstrated the clinical symptoms of EoE following SLIT. She was receiving SLIT with a combination of hazelnut, birch, and alder extracts for the treatment of her allergic rhinitis and asthma and Bauer et al [98] also reported a 9-year-old autistic boy with a history of allergic rhinoconjunctivitis, asthma, and severe feeding disturbance.…”

Section: Slit and Eoementioning

confidence: 99%

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Oral and Sublingual Immunotherapy: Potential Causes for Eosinophilic Gastrointestinal Disorders?

Babaie

Mesdaghi

Nishino

et al. 2017

Int Arch Allergy Immunol

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Food allergy is a common health problem worldwide, with increasing prevalence during recent decades. The only approved treatments for food allergy are food avoidance and administration of emergency medications in case of accidental exposure, which negatively affects patients' quality of life, so new treatments are highly desirable. Different food immunotherapy modalities have recently been used, with variable success rates in the induction of desensitization and tolerance, and different numbers and types of adverse reactions. Adverse reactions, especially intolerable gastrointestinal symptoms, are the most important causes of immunotherapy withdrawal. Eosinophilic esophagitis has been reported as a complication of milk, egg, and peanut oral immunotherapies and sublingual immunotherapy for respiratory allergies, but not for food allergies. Eosinophilic gastritis and eosinophilic colitis also rarely happened following egg and milk oral immunotherapies. The patients undergoing oral and sublingual immunotherapies should be closely followed up for a long time, and those with gastrointestinal symptoms should be evaluated by endoscopy of the gastrointestinal tract. These complications are usually reversible after early diagnosis and stopping the immunotherapy protocol.

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“…With increasing awareness for EoE in the future, it is likely that dysphagia itself will become the most prominent symptom leading to a rapid diagnosis of EoE in adults. Dysphagia may also be a quite early event in the development of EoE as suggested by a case of a 44-year-old woman who rapidly developed a full clinical picture of de novo EoE including severe dysphagia, confluent white exudates on endoscopy and severe eosinophilic inflammation of esophageal biopsies within the first 4 weeks of sublingual immunotherapy for hay fever [11]. …”

Section: Symptom Presentation Of Eoementioning

confidence: 99%

Clinical Features of Eosinophilic Esophagitis

Miehlke¹

2014

Dig Dis

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Eosinophilic esophagitis (EoE) may affect individuals at any age with a predominance for Caucasian males. The clinical manifestation of EoE is strongly age dependent. While dysphagia and food impaction are typical lead symptoms in adults and adolescents, infants often present with unspecific symptoms such as feeding problems, abdominal pain and vomiting. Some EoE patients may also experience heartburn. Therefore, EoE should always be considered in cases of heartburn refractory to antireflux therapy. Concomitant allergic diseases such as asthma, rhinitis and eczema are prevalent. Peripheral eosinophilia and elevated total serum IgE values are found in up to 50 and 70% of cases, respectively. Endoscopic features of EoE are variable and none of them is pathognomonic. Frequent findings are mucosal edema, furrows, exudates and corrugated rings. These endoscopic abnormalities have high specificities (90-95%), but low sensitivities (15-48%). A novel grading and classification system for the endoscopic assessment of EoE has been proposed which includes fixed rings, exudates, furrows and edema as major features. This classification system demonstrated good interobserver agreement among pediatric and adult gastroenterologists, and presents a useful tool to standardize endoscopic assessments and to further investigate the relation between endoscopic manifestation, clinical activity and response to treatment in EoE. Long-term follow-up studies have shown that EoE is a chronic disease causing recurrent dysphagia in the majority of cases. The prevalence of strictures significantly increases with the duration of disease, which stresses the importance of early diagnosis and consequent treatment of EoE.

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Induction of Eosinophilic Esophagitis by Sublingual Pollen Immunotherapy

Cited by 118 publications

References 13 publications

Eosinophilic esophagitis: New insights in pathogenesis and therapy

Eosinophilic esophagitis: New insights in pathogenesis and therapy

Oral and Sublingual Immunotherapy: Potential Causes for Eosinophilic Gastrointestinal Disorders?

Clinical Features of Eosinophilic Esophagitis

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