ABSTRACT
Eosinophilic esophagitis is a chronic antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by TH2 inflammation (at least 15 eosinophils/high power field) when other secondary systemic and local causes of esophageal eosinophilia are excluded. Although this disease was initially ascribed to a delayed reaction to food allergens, emerging evidence suggests that aeroallergens may also play a role in pathogenesis and disease course. Some studies support seasonal variations in the diagnosis of eosinophilic esophagitis and disease exacerbations owing to the increase in aeroallergens to which patients are sensitized. It is also known that this disease can be caused by extensive, identifiable exposure to aeroallergens and after treatment with specific immunotherapy based on food or aeroallergens. It was recently postulated that treatment of allergic rhinoconjunctivitis can improve the symptoms of eosinophilic esophagitis, although data are limited to case reports and small series. Currently, biomarkers and biologic therapies are not helpful for diagnosis or inducing clinical and histological remission of the disease. Nevertheless, there are high hopes for dupilumab. This review aims to give visibility to the involvement of aeroallergens in the triggering and exacerbation of eosinophilic esophagitis, since many of them, in addition to being airborne and inhalant, can also be ingested as food. Clearly, we must try to identify the cause of the disease to ensure remission.
Subject(s)
Eosinophilic Esophagitis , Food Hypersensitivity , Humans , Eosinophilic Esophagitis/diagnosis , Eosinophilic Esophagitis/etiology , Eosinophilic Esophagitis/therapy , Allergens , Eosinophils , Disease ProgressionSubject(s)
Dermatitis, Allergic Contact , Dermatitis, Contact , Hypersensitivity , Acrylates/adverse effects , Allergens , Camphanes/adverse effects , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Allergic Contact/etiology , Glucose , Humans , Hypersensitivity/complications , Patch Tests/adverse effectsABSTRACT
Eosinophilic esophagitis is a chronic antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by TH2 inflammation (at least 15 eosinophils/high power field) when other secondary systemic and local causes of esophageal eosinophilia are excluded. Although this disease was initially ascribed to a delayed reaction to food allergens, emerging evidence suggests that aeroallergens may also play a role in pathogenesis and disease course. Some studies support seasonal variations in the diagnosis of eosinophilic esophagitis and disease exacerbations owing to the increase in aeroallergens to which patients are sensitized. It is also known that this disease can be caused by extensive, identifiable exposure to aeroallergens and after treatment with specific immunotherapy based on food or aeroallergens. It was recently postulated that treatment of allergic rhinoconjunctivitis can improve the symptoms of eosinophilic esophagitis, although data are limited to case reports and small series. Currently, biomarkers and biologic therapies are not helpful for diagnosis or inducing clinical and histological remission of the disease. Nevertheless, there are high hopes for dupilumab. This review aims to give visibility to the involvement of aeroallergens in the triggering and exacerbation of eosinophilic esophagitis, since many of them, in addition to being airborne and inhalant, can also be ingested as food. Clearly, we must try to identify the cause of the disease to ensure remission. (AU)
Subject(s)
Humans , Rhinitis, Allergic, Seasonal/immunology , Eosinophilic Esophagitis/immunology , Allergens/immunology , Symptom Flare Up , Seasons , Diagnosis, Differential , Comorbidity , Pollen/immunologyABSTRACT
BACKGROUND AND OBJECTIVE: Eosinophilic esophagitis (EoE) is a chronic and isolated inflammation of the esophagus characterized by a marked infiltration of eosinophilic leukocytes. Diagnosis and course of the disease are based exclusively on histopathology. Therefore, patients must undergo several esophageal biopsies, implying a risk associated with the procedure and considerable use of resources. Objective: The presence of active circulating eosinophils, which are quantifiable through the expression of specific cellular activation proteins in their membrane, could be consistent with histopathological findings, which are currently the only valid parameters in studies on EoE. METHODS: The activity of peripheral blood eosinophils from patients with EoE was analyzed by identifying 5 surface molecules (CD69, IL- 5Rα, CD44, ICAM-1, CD63), which are seen to be expressed by the active eosinophils in flow cytometry. The results were compared with the infiltrate of eosinophils present in patients' esophageal biopsies. RESULTS: ICAM-1 levels decreased significantly in patients with active EoE compared with nonactive EoE patients, allergic patients, and healthy controls. In patients with EoE, an inverse correlation was observed between the number of eosinophils in the esophageal biopsy and the percentage of ICAM-1 expression in peripheral blood eosinophils. No differences were observed for the remaining molecules studied. CONCLUSION: Expression of ICAM-1 in blood eosinophils could be a useful noninvasive marker for the diagnosis and assessment of patients with EoE.
Subject(s)
Blood Cells/immunology , Eosinophilic Esophagitis/immunology , Eosinophils/immunology , Esophagus/immunology , Intercellular Adhesion Molecule-1/metabolism , Adolescent , Adult , Biomarkers/metabolism , Biopsy , Down-Regulation , Female , Humans , Intercellular Adhesion Molecule-1/genetics , Male , Middle Aged , Young AdultSubject(s)
Allergens/immunology , Anaphylaxis/diagnosis , Asthma, Exercise-Induced/diagnosis , Food Hypersensitivity/diagnosis , Profilins/immunology , Adult , Child , Eating , Fruit , Humans , Male , Skin TestsABSTRACT
Background: Eosinophilic esophagitis (EoE) is a chronic and isolated inflammation of the esophagus characterized by a marked infiltration of eosinophilic leukocytes. Diagnosis and course of the disease are based exclusively on histopathology. Therefore, patients must undergo several esophageal biopsies, implying a risk associated with the procedure and considerable use of resources. Objective: The presence of active circulating eosinophils, which are quantifiable through the expression of specific cellular activation proteins in their membrane, could be consistent with histopathological findings, which are currently the only valid parameters in studies on EoE. Methods: The activity of peripheral blood eosinophils from patients with EoE was analyzed by identifying 5 surface molecules (CD69, IL- 5Rα, CD44, ICAM-1, CD63), which are seen to be expressed by the active eosinophils in flow cytometry. The results were compared with the infiltrate of eosinophils present in patients esophageal biopsies. Results: ICAM-1 levels decreased significantly in patients with active EoE compared with nonactive EoE patients, allergic patients, and healthy controls. In patients with EoE, an inverse correlation was observed between the number of eosinophils in the esophageal biopsy and the percentage of ICAM-1 expression in peripheral blood eosinophils. No differences were observed for the remaining molecules studied. Conclusion: Expression of ICAM-1 in blood eosinophils could be a useful noninvasive marker for the diagnosis and assessment of patients with EoE (AU)
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Blood Cells/immunology , Eosinophilic Esophagitis/blood , Eosinophilic Esophagitis/immunology , Intercellular Adhesion Molecule-1/blood , Intercellular Adhesion Molecule-1/metabolism , Biomarkers/blood , Down-RegulationSubject(s)
Humans , Male , Child , Adult , Asthma, Exercise-Induced/diagnosis , Food Hypersensitivity/diagnosis , Allergens/immunology , Anaphylaxis/diagnosis , Profilins/immunology , Fruit , Skin TestsSubject(s)
Allergens/administration & dosage , Desensitization, Immunologic/methods , Egg Hypersensitivity/epidemiology , Egg Proteins, Dietary/administration & dosage , Eosinophilic Esophagitis/epidemiology , Eosinophils/pathology , Administration, Oral , Adolescent , Allergens/adverse effects , Child , Child, Preschool , Comorbidity , Desensitization, Immunologic/adverse effects , Egg Hypersensitivity/therapy , Egg Proteins, Dietary/adverse effects , Female , Humans , Immunoglobulin E/blood , Infant , Male , Prospective Studies , Spain/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Allergens/administration & dosage , Desensitization, Immunologic/methods , Egg Hypersensitivity/epidemiology , Egg Proteins, Dietary/administration & dosage , Eosinophilic Esophagitis/epidemiology , Eosinophils/pathology , Administration, Oral , Allergens/adverse effects , Comorbidity , Desensitization, Immunologic/adverse effects , Egg Hypersensitivity/therapy , Egg Proteins, Dietary/adverse effects , Immunoglobulin E/blood , Prospective Studies , Spain/epidemiologySubject(s)
Anaphylaxis/chemically induced , Serum Albumin, Human/adverse effects , Adenocarcinoma/drug therapy , Anaphylaxis/blood , Anaphylaxis/diagnosis , Anaphylaxis/immunology , Colonic Neoplasms/drug therapy , Humans , Immune Tolerance , Immunoglobulin E/blood , Immunologic Tests , Male , Middle Aged , PlasmaABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Anaphylaxis/immunology , Serum Albumin, Human/adverse effects , Hypersensitivity, Immediate/immunology , Haptoglobins/deficiency , Drug Hypersensitivity/immunology , Skin Tests/methodsABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Eosinophilic Esophagitis/diet therapy , Food Hypersensitivity/diet therapy , Diet/standards , Immunoglobulin E/analysis , Eosinophilic Esophagitis/immunology , Biopsy/methods , 24457/standardsABSTRACT
No disponible
