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

Ram, Gita; Lee, Ju Hee; Ott, Megan T.; Brown-Whitehorn, Terri F.; Cianferoni, Antonella; Shuker, Michele; Wang, Mei-Lun; Verma, Ritu; Liacouras, Chris A.; Spergel, Jonathan M.

doi:10.1016/j.anai.2015.07.004

Cited by 99 publications

(64 citation statements)

References 22 publications

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“…), suggesting that these conditions are pathophysiologically related [25]. In addition, reactions to food allergens alone are not solely responsible for the inflammation observed in EoE as some EoE patients with concurrent allergic rhinitis display seasonal exacerbations of esophageal eosinophilia [26]. Consistent with EoE falling on the allergic spectrum, the inflammation observed in EoE responds to allergen avoidance and/or topical steroid applications.…”

Section: Introductionmentioning

confidence: 99%

The Immunologic Mechanisms of Eosinophilic Esophagitis

Hill

Spergel

2016

Curr Allergy Asthma Rep

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Eosinophilic esophagitis (EoE) is a chronic allergic inflammatory disease that is triggered by food and/or environmental allergens and is characterized by a clinical and pathologic phenotype of progressive esophageal dysfunction due to tissue inflammation and fibrosis. EoE is suspected in patients with painful swallowing, among other symptoms, and is diagnosed by the presence of 15 or more eosinophils per high-power field in one or more of at least four esophageal biopsy specimens. The prevalence of EoE is increasing and has now reached rates similar to those of other chronic gastrointestinal disorders such as Crohn’s disease. In recent years, our understanding of the immunologic mechanisms underlying this condition has grown considerably. Thanks to new genetic, molecular, cellular, animal, and translational studies, we can now postulate a detailed pathway by which exposure to allergens results in a complex and coordinated type 2 inflammatory cascade that, if not intervened upon, can result in pain on swallowing, esophageal strictures, and food impaction. Here, we review the most recent research in this field to synthesize and summarize our current understanding of this complex and important disease.

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Section: Introductionmentioning

confidence: 99%

The Immunologic Mechanisms of Eosinophilic Esophagitis

Hill

Spergel

2016

Curr Allergy Asthma Rep

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“…Many EoE patients present rhinoconjunctivitis, atopic dermatitis and associated asthma, in addition to dysphagia and food impaction. EoE exacerbations are often seasonal …”

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confidence: 99%

Germination of pollen grains in the oesophagus of individuals with eosinophilic oesophagitis

Armentia

Martín-Armentia

Álvarez‐Nogal

et al. 2018

Clin Experimental Allergy

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“…Although the association of EoE with total IgE levels, as well as with IgE sensitization to food, airborne, and cross‐reacting allergens is clear, the causation between type 1‒mediated hypersensitivity and EoE is still unclear . The seasonal incidence of EoE helps support causation, but additional evidence can also be found in the immunotherapy literature . There are reports for oral immunotherapy with food allergens and sublingual immunotherapy with aeroallergens triggering endoscopically and pathologically confirmed EoE, which resolved after withdrawal of therapy …”

Section: Discussionmentioning

confidence: 99%

Esophageal IgE, IgG4, and mucosal eosinophilia in individuals with dysphagia

Ramaswamy¹,

Anderson

et al. 2019

Int Forum Allergy Rhinol

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Background Eosinophilic esophagitis (EoE) is an inflammatory disease of the esophagus, producing failure to thrive in infants and dysphagia with food impaction in older children and adults. Although most people with EoE manifest atopic/allergic disease, the specific allergens to which immunoglobulin E (IgE) is directed, if any, have not yet been characterized. Methods Mucosal brush biopsy (MBB) and solid tissue biopsy (STB) specimens were prospectively obtained from 25 individuals with dysphagia and suspicion of EoE. Specific IgE (sIgE) against 112 epitopes from airborne and food proteins, antigens known to cause a polyclonal IgE response and IgG4 to food allergens, were measured. Results There was no difference in total IgE harvested between the 2 biopsy methods (p > 0.05) or between the EoE‐positive (N = 12) and EoE‐negative (N = 13) groups (p > 0.05). None of the samples in either group contained measurable serum IgE to any of the airborne or food proteins tested, but low levels of IgE specific to Candida and Staphylococcus enterotoxins were detected. Low levels of IgG4 specific to wheat, soy, peanut, and egg were also detected. Conclusions Both MBB and STB are able to harvest measureable levels of IgE and IgG4 from the esophageal mucosa. Low levels of serum‐specific IgE suggest that other inflammatory mechanisms, besides type I, IgE‐mediated, allergen‐specific hypersensitivity, may act as the primary catalyst for mucosal eosinophilia. Clarifying the role of both IgE‐mediated and non‒IgE‐mediated inflammatory mechanisms will help identify more targeted diagnostic and treatment strategies for individuals who present with dysphagia and esophageal eosinophilia.

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

Cited by 99 publications

References 22 publications

The Immunologic Mechanisms of Eosinophilic Esophagitis

The Immunologic Mechanisms of Eosinophilic Esophagitis

Germination of pollen grains in the oesophagus of individuals with eosinophilic oesophagitis

Esophageal IgE, IgG4, and mucosal eosinophilia in individuals with dysphagia

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