ABSTRACT
UNLABELLED: Eosinophilic oesophagitis is an emerging disease, well known also in paediatric age, probably caused by both IgE and non-IgE mediated food allergies, diagnosed by upper endoscopy with biopsy. The most severe complication is oesophageal stenosis. The identification of the offending allergens is often difficult; therapy is focused to eliminate the supposed antigenic stimulus, to control the acute symptoms and to induce long-term remission. AIM: We report the clinical outcome and the typical endoscopic findings of children and adolescents affected by eosinophilic oesophagitis, referring a proposal of diagnostic and treatment protocol. PATIENTS AND METHODS: Twelve patients, affected by eosinophilic oesophagitis with a histological diagnosis, underwent radiographic upper gastro-intestinal series, 24 h pH-probe and standardised allergic testing; they were treated with steroids (oral prednisone and swallowed aerosolised fluticasone) and elimination diet. Dilations were performed when eosinophilic oesophagitis was not yet diagnosed, or in patients resistant to conventional treatment. RESULTS: Two patients were lost to follow up (mean follow up: 1 year 11 months); seven patients have no symptoms and normal histology, five of them on restricted diet (without cow's milk protein) and two patients on elemental diet (amino acid formula). In two patients (no allergens identified), mild dysphagia and eosinophilic infiltration persist; one patients underwent Nissen fundoplication for Barrett's oesophagus: he has no symptoms and normal oesophagus, on restricted diet (without cow's milk/eggs protein and wheat). CONCLUSION: The recognition of typical endoscopic picture with careful biopsies extended to the whole oesophagus, even in emergency, could more quickly lead to the correct diagnosis and avoid severe complications of eosinophilic oesophagitis in children, as stricture and failure to growth. Elimination diet is the key of resolution when the allergens are identified. A great challenge remains the relation between gastro-oesophageal reflux disease and eosinophilic oesophagitis, which should however be explained.
Subject(s)
Eosinophilia/diagnosis , Eosinophilia/therapy , Esophagitis/diagnosis , Esophagitis/therapy , Food Hypersensitivity/complications , Administration, Inhalation , Administration, Oral , Adolescent , Aerosols , Androstadienes/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Biopsy , Catheterization , Child , Child, Preschool , Endoscopy, Digestive System , Eosinophilia/etiology , Esophageal pH Monitoring , Esophagitis/etiology , Female , Fluticasone , Food Hypersensitivity/diagnosis , Food Hypersensitivity/therapy , Humans , Immunoglobulin E/blood , Infant , Male , Prednisone/therapeutic use , Prospective Studies , Retrospective Studies , Skin Tests , Upper Gastrointestinal Tract/pathologyABSTRACT
A group of 35 children affected by bronchial asthma, rhinitis and/or allergic conjunctivitis was examined; the children selected for the study had never undergone ITS before; all patients had received preventive drug and nondrug therapy for several months but none had succeeded in significantly reducing allergic clinical symptoms. Subcutaneous ITS Lofarma was prescribed for all patients (for various allergens) and blocking antibodies (IgG1 + IgG4) were assayed using a RAST system (Kit-Pharmacia) before the start of the study, and after 3, 9 and 12 months of therapy; 25 nonatopic children represented the control group. Although a certain number of allergen-specific blocking antibodies were present in all patients before the start of ITS, a significant increase in IgG1 + IgG4 specific allergens was observed after 9 months (especially for pollenosis). Compatible results were also obtained for blocking antibodies for children affected by dermatophagoides following 12 months of ITS. The aim of the present study was to evaluate the extent of the appearance of blocking antibodies in the circulation following ITS and to discover whether or not there was a correlation between their increased titre and improvement of the disease assessed by the use of clinical scores.
Subject(s)
Antibodies/blood , Desensitization, Immunologic , Respiratory Hypersensitivity/immunology , Adolescent , Antibody Specificity/immunology , Binding, Competitive , Child , Child, Preschool , Desensitization, Immunologic/methods , Humans , Immunoglobulin E/analysis , Respiratory Hypersensitivity/therapy , Skin Tests , Time FactorsABSTRACT
A review of 104 children affected with respiratory tract allergies and or rhinoconjunctivitis in hyposensitizing therapy against gramineae pollens or moulds or house dust or Mix dermatophagoides is presented. Clinical evaluations were carried out in order to evaluate the clinical improvement after 1 year and after 4 years therapy (TIS). The best results were detected after 4 years obviously and in some allergic diseases more improvement were found from the authors. The most important results were obtained in bronchial asthma; the worse benefits were detected in allergic conjunctivitis.
