The development of IgE-mediated immediate hypersensitivity after the diagnosis of eosinophilic esophagitis to the same food

Hill, David R.C.; Shuker, Michele; Cianferoni, Antonella; Wong, Tracie; Ruchelli, Eduardo D.; Spergel, Jonathan M.; Brown-Whitehorn, Terri F.

doi:10.1016/j.jaip.2014.08.005

Cited by 45 publications

(33 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While IgE-mediated and EoE food allergy have been reported to occur together, (14, 15, 23, 28) it is difficult to estimate simultaneous occurrence of these conditions to the same food as avoidance of the causal food in IgE-mediated food allergy ameliorates EoE symptoms. Additionally, patients with EoE and IgE-mediated food allergy may display distinct clinical symptoms as compared to those without IgE-mediated food allergy, making EoE diagnosis difficult.…”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Eosinophilic Esophagitis in Pediatric Patients with IgE-Mediated Food Allergy

Hill

Dudley

Spergel

2017

The Journal of Allergy and Clinical Immunology: In Practice

Self Cite

107

View full text Add to dashboard Cite

BACKGROUND Eosinophilic esophagitis (EoE) is an allergic inflammatory disease that is triggered by food allergens and characterized by progressive esophageal dysfunction. Recently, EoE has been identified in patients undergoing oral immunotherapy (OIT) for IgE-mediated food allergy, suggesting an association. OBJECTIVE We sought to ascertain whether significant associations exist between IgE-mediated food allergies and EoE. METHODS Utilizing analysis of EMR data and manual chart review, we examined our sub-specialty care network of 35,528 children and adolescents to identify and characterize patients with IgE-mediated, and EoE food allergy. The most common food allergens were defined, and the prevalence of EoE in patients with IgE-mediated food allergy was determined. Logistic regression was used to measure the extent to which IgE-mediated food allergy to specific foods is associated with EoE. RESULTS The most common causes of EoE were milk, grains, meats, peanut, tree nuts, egg, and soy, an allergen pattern that is distinct from that of IgE-mediated food allergy. The prevalence of EoE in patients with IgE-mediated food allergy was higher than that reported in the general population (4.7% vs 0.04%). The distribution of IgE-mediated food allergens in patients with EoE was similar to that of the general population, and IgE-mediated allergy to egg (2.27; 1.91–2.64), milk (4.19; 3.52–4.97), or shellfish (1.55; 1.24–1.92) was significantly associated with EoE diagnosis. CONCLUSIONS Our findings support a clinical association between these conditions that has implications for the management of children with food allergy, and particular relevance to patients undergoing OIT.

show abstract

Section: Discussionmentioning

confidence: 99%

The Prevalence of Eosinophilic Esophagitis in Pediatric Patients with IgE-Mediated Food Allergy

Hill

Dudley

Spergel

2017

The Journal of Allergy and Clinical Immunology: In Practice

Self Cite

107

View full text Add to dashboard Cite

show abstract

“…For example, IgE-mediated food allergy and EoE seem to occur independently [93, 94]. Additionally, patients with milk-induced EoE do not outgrow their disease which is in contrast to IgE-mediated allergy where 75 % of children become tolerant by the early teenage years [7, 95, 96].…”

Section: Cytokines Chemokines and Other Moleculesmentioning

confidence: 99%

The Immunologic Mechanisms of Eosinophilic Esophagitis

Hill

Spergel

2016

Curr Allergy Asthma Rep

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…A common goal with long‐term care of patients with EoE on dietary elimination therapy is to narrow the list of foods being removed over time. This will ensure increasing dietary choices over time, hence better chronic adherence to the diet, and the potential for avoidance of the risk of a de novo immediate IgE‐mediated clinical reactivity to a food following its prolonged avoidance, although the latter is very rarely reported . Diet liberalization is commonly done by reintroduction of one food at a time, followed by clinical and histological evaluation .…”

Section: Current Therapies For Eoementioning

confidence: 99%

“…This will ensure increasing dietary choices over time, hence better chronic adherence to the diet, and the potential for avoidance of the risk of a de novo immediate IgE-mediated clinical reactivity to a food following its prolonged avoidance, although the latter is very rarely reported. 68 Diet liberalization is commonly done by reintroduction of one food at a time, followed by clinical and histological evaluation. 65,69 The challenge with reintroduction of foods is its trial-and-error nature, with the process often resulting in multiple endoscopies with biopsies before a final list of food triggers is identified for long-term avoidance.…”

Section: Dietary Therapymentioning

confidence: 99%

Eosinophilic esophagitis: current perspectives from diagnosis to management

Moawad

Cheng

Schoepfer

et al. 2016

Annals of the New York Academy of Sciences

View full text Add to dashboard Cite

Eosinophilic esophagitis (EoE) is a chronic antigen-mediated immune disease of the esophagus characterized by symptoms related to esophageal dysfunction, as well as significant esophageal eosinophilia. Although dense eosinophilia is the hallmark of EoE, other characteristic histologic features have been described that may help distinguish EoE from other competing diagnoses, although none are specific to EoE. One or more foods and, at times, environmental allergens trigger EoE. Left untreated, esophageal inflammation in EoE may lead to esophageal remodeling and stricture formation. Symptoms in EoE vary with age, as they relate to the progression of the disease from an inflammatory to a fibrostenotic phenotype over time. There are currently no U.S. Food and Drug Administration-approved therapies for EoE. Current options include various dietary-restriction therapies, topical corticosteroids, and esophageal dilations. Several emerging therapies aiming at restoring the esophageal barrier function or targeting various inflammatory cells or their mediators are under investigation.

show abstract

The development of IgE-mediated immediate hypersensitivity after the diagnosis of eosinophilic esophagitis to the same food

Cited by 45 publications

References 6 publications

The Prevalence of Eosinophilic Esophagitis in Pediatric Patients with IgE-Mediated Food Allergy

The Prevalence of Eosinophilic Esophagitis in Pediatric Patients with IgE-Mediated Food Allergy

The Immunologic Mechanisms of Eosinophilic Esophagitis

Eosinophilic esophagitis: current perspectives from diagnosis to management

Contact Info

Product

Resources

About