Esophageal hypereosinophilia induced by grass sublingual immunotherapy

• Published in: Journal of allergy and clinical immunology Vol. 133; no. 5; pp. 1482 - 1484
• Main Authors: Antico, Andrea, MD, Fante, Rossella, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2014; Elsevier; Elsevier Limited
• Subjects: Adult; Allergens - administration & dosage; Allergens - adverse effects; Allergies; Allergy and Immunology; Biological and medical sciences; Biopsy; Dysphagia; Eosinophilia - chemically induced; Eosinophilia - immunology; Eosinophilia - pathology; Esophageal Diseases - chemically induced; Esophageal Diseases - immunology; Esophageal Diseases - pathology; Food; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Gastroesophageal reflux; Hematologic and hematopoietic diseases; Humans; Immunopathology; Immunotherapy; Male; Medical sciences; Other diseases. Hematologic involvement in other diseases; Pathogenesis; Pediatrics; Plant reproduction; Poaceae; Pollen; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Seasons; Sublingual Immunotherapy - adverse effects; Vaccines; Immunopathology; Desensitization; Immunology; Digestive system; Sublingual administration; Hemopathy; Eosinophilia; Esophagus
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2014.01.030

Approximately 1 month later, the patient began to experience a mild sensation of retrosternal constriction, which worsened over the next few days with retrosternal pain and dysphagia related to tablet and food ingestion. Because of the suspicion of gastroesophageal reflux, a course of proton pump inhibitors (PPIs; 40 mg/d pantoprazole), prokinetic agents, antacids, and alginate was prescribed without any improvement. Long-term evolution of esophageal eosinophilia is not known. [...]we suggest considering the occurrence of esophagitis symptoms with esophageal eosinophilia as an absolute contraindication to continuing sublingual therapy with the culprit vaccine.