Allergen immunotherapy and eosinophilic esophagitis: friends or foes?
The connection between eosinophilic esophagitis (EoE) and food and airborne allergens is complex. Exposure to allergens (mainly food) is often the trigger for EoE flares. The development of EoE has been described as a side effect of allergen immunotherapy, especially oral immunotherapy (OIT, with fo...
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| Published in: | Current opinion in allergy and clinical immunology Vol. 24; no. 6; pp. 504 - 509 |
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| Abstract | The connection between eosinophilic esophagitis (EoE) and food and airborne allergens is complex. Exposure to allergens (mainly food) is often the trigger for EoE flares. The development of EoE has been described as a side effect of allergen immunotherapy, especially oral immunotherapy (OIT, with food allergens), while isolated cases of EoE have been reported during sublingual immunotherapy (SLIT, with extracts of aeroallergens).
EoE is currently recognized as a common side effect of OIT, while a solid correlation between SLIT and EoE is missing. Animal models have been developed to study the pathophysiological link between sensitization to aeroallergens and the induction of EoE and will probably provide an interpretation of why there are cases of EoE developed during SLIT. Recent findings in animal models suggest a genetic connection to EoE development after sensitization and re-exposure to airborne allergens. Subcutaneous allergen immunotherapy does not have a causative effect on EoE; on the contrary, a beneficial effect on EoE has been reported. Moreover, epicutaneous immunotherapy with a vector containing milk has also been used to treat children with milk-induced EoE.
Discovering the immune links between allergens and EoE will further guide the proper use of allergen immunotherapy and help define future strategies for the management of EoE. |
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| AbstractList | The connection between eosinophilic esophagitis (EoE) and food and airborne allergens is complex. Exposure to allergens (mainly food) is often the trigger for EoE flares. The development of EoE has been described as a side effect of allergen immunotherapy, especially oral immunotherapy (OIT, with food allergens), while isolated cases of EoE have been reported during sublingual immunotherapy (SLIT, with extracts of aeroallergens).
EoE is currently recognized as a common side effect of OIT, while a solid correlation between SLIT and EoE is missing. Animal models have been developed to study the pathophysiological link between sensitization to aeroallergens and the induction of EoE and will probably provide an interpretation of why there are cases of EoE developed during SLIT. Recent findings in animal models suggest a genetic connection to EoE development after sensitization and re-exposure to airborne allergens. Subcutaneous allergen immunotherapy does not have a causative effect on EoE; on the contrary, a beneficial effect on EoE has been reported. Moreover, epicutaneous immunotherapy with a vector containing milk has also been used to treat children with milk-induced EoE.
Discovering the immune links between allergens and EoE will further guide the proper use of allergen immunotherapy and help define future strategies for the management of EoE. The connection between eosinophilic esophagitis (EoE) and food and airborne allergens is complex. Exposure to allergens (mainly food) is often the trigger for EoE flares. The development of EoE has been described as a side effect of allergen immunotherapy, especially oral immunotherapy (OIT, with food allergens), while isolated cases of EoE have been reported during sublingual immunotherapy (SLIT, with extracts of aeroallergens).PURPOSE OF REVIEWThe connection between eosinophilic esophagitis (EoE) and food and airborne allergens is complex. Exposure to allergens (mainly food) is often the trigger for EoE flares. The development of EoE has been described as a side effect of allergen immunotherapy, especially oral immunotherapy (OIT, with food allergens), while isolated cases of EoE have been reported during sublingual immunotherapy (SLIT, with extracts of aeroallergens).EoE is currently recognized as a common side effect of OIT, while a solid correlation between SLIT and EoE is missing. Animal models have been developed to study the pathophysiological link between sensitization to aeroallergens and the induction of EoE and will probably provide an interpretation of why there are cases of EoE developed during SLIT. Recent findings in animal models suggest a genetic connection to EoE development after sensitization and re-exposure to airborne allergens. Subcutaneous allergen immunotherapy does not have a causative effect on EoE; on the contrary, a beneficial effect on EoE has been reported. Moreover, epicutaneous immunotherapy with a vector containing milk has also been used to treat children with milk-induced EoE.RECENT FINDINGSEoE is currently recognized as a common side effect of OIT, while a solid correlation between SLIT and EoE is missing. Animal models have been developed to study the pathophysiological link between sensitization to aeroallergens and the induction of EoE and will probably provide an interpretation of why there are cases of EoE developed during SLIT. Recent findings in animal models suggest a genetic connection to EoE development after sensitization and re-exposure to airborne allergens. Subcutaneous allergen immunotherapy does not have a causative effect on EoE; on the contrary, a beneficial effect on EoE has been reported. Moreover, epicutaneous immunotherapy with a vector containing milk has also been used to treat children with milk-induced EoE.Discovering the immune links between allergens and EoE will further guide the proper use of allergen immunotherapy and help define future strategies for the management of EoE.SUMMARYDiscovering the immune links between allergens and EoE will further guide the proper use of allergen immunotherapy and help define future strategies for the management of EoE. |
| Author | Rossi, Carlo Maria Pitsios, Constantinos |
| Author_xml | – sequence: 1 givenname: Constantinos surname: Pitsios fullname: Pitsios, Constantinos organization: Allergy Outpatient Clinic, General Hospital of Nicosia, Nicosia, Cyprus – sequence: 2 givenname: Carlo Maria surname: Rossi fullname: Rossi, Carlo Maria organization: Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/39270037$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.23822/EurAnnACI.1764-1489.311 10.1038/ajg.2008.169 10.1177/0194599810392655 10.1111/pai.13458 10.2147/JIR.S372449 10.1016/j.jaci.2012.10.057 10.1111/all.14659 10.3390/medicina56110618 10.1016/j.jaci.2024.04.010 10.1189/jlb.0110025 10.1159/000509119 10.1016/j.jaip.2018.05.010 10.1002/ame2.12391 10.1016/j.cgh.2019.05.014 10.1016/j.cgh.2023.06.005 10.1007/BF01296781 10.1016/j.anai.2017.11.016 10.1136/bcr-2017-223465 10.1016/j.anai.2014.08.004 10.1016/j.anai.2015.07.004 10.1016/j.jaip.2021.07.048 10.1007/s12328-021-01520-5 10.1111/j.1365-2036.2009.04199.x 10.1016/j.anai.2018.12.013 10.1080/03007995.2018.1552044 10.1097/01.mcg.0000248019.16139.67 10.2147/JAA.S238565 10.1111/cea.12312 10.1172/JCI10224 10.1186/s13223-018-0287-0 10.1097/MPG.0000000000001245 10.1002/ueg2.12465 10.1371/journal.pone.0031967 10.1111/apt.13129 10.1111/all.13486 10.1177/2050640616689525 10.1016/j.anai.2019.02.022 |
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| References | Ram (R17-20241115) 2015; 115 Spergel (R38-20241115) 2020; 18 Burk (R10-20241115) 2024; 153 Wells (R23-20241115) 2018; 2018 Mondoulet (R37-20241115) 2012; 7 Varkey (R41-20241115) 2021; 30 Pitsios (R20-20241115) 2024; 56 Almansa (R30-20241115) 2009; 104 Larsson (R18-20241115) 2011; 144 Roberts (R6-20241115) 2024; 12 Wilson (R40-20241115) 2023; 11 Commins (R32-20241115) 2024; 153 Li (R24-20241115) 2024; 7 Moawad (R28-20241115) 2010; 31 Maskey (R27-20241115) 2022; 15 Pitsios (R43-20241115) 2019; 35 Attwood (R2-20241115) 1993; 38 Calderon (R33-20241115) 2016; 137 Petroni (R14-20241115) 2018; 120 Lucendo (R13-20241115) 2014; 113 Reed (R19-20241115) 2019; 122 Lucendo (R1-20241115) 2017; 5 Straumann (R3-20241115) 1994; 124 Rayapudi (R25-20241115) 2010; 88 Mishra (R26-20241115) 2001; 107 Hill (R7-20241115) 2018; 6 Nilsson (R12-20241115) 2021; 9 Fujiwara (R22-20241115) 2021; 14 Dioszeghy (R36-20241115) 2014; 44 Fahey (R16-20241115) 2017; 64 Votto (R42-20241115) 2021; 32 Robey (R31-20241115) 2019; 122 De Swert (R34-20241115) 2013; 131 Wilson (R9-20241115) 2020; 13 Hahn (R5-20241115) 2023; 21 Dellon (R4-20241115) 2015; 41 Spergel (R39-20241115) 2020; 76 Cianferoni (R8-20241115) 2020; 56 Carr (R21-20241115) 2018; 14 Rosenberg (R35-20241115) 2018; 73 Wang (R29-20241115) 2007; 41 |
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