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Eosinophilic
Esophagitis
It is well
known that foods can cause a variety of G-I complaints
through a variety of non-immunologic and immunologic
reactions. Eosinophilic esophagitis (EE) is
one such entity that has gained increased recognition
over the past decade. Eosinophils are the classic
"allergy" cell implicated in the pathogenesis
of both asthma and allergic rhinitis. EE patients
have an abnormal accumulation of eosinophils in the
esophagus, the main digestive tube leading to the
stomach. EE can manifest in any number of ways
depending on age of patient and severity of the eosinophilic
accumulation. Younger patients typically manifest
failure to thrive/poor weight gain, and frequent "spitting
up". Older patients may manifest difficulty
swallowing, food impaction, abdominal and/or chest
pain.
EE is an active area of research.
In numerous studies, foods have been shown to be causative
in EE. Thus far, it is believed that EE is the
result of both Type 1 (immediate) and Type 4 (delayed)
hypersensitivity to food.
While inhaled corticosteroids and
perhaps other anti-inflammatory agents have been shown
to be effective, identification and elimination of
the food trigger provides a more direct approach.
This is accomplished by a variety of testing methods,
ie., serologic, prick and patch testing. This
is 75%* effective. Elemental diets can be effective,
but patient compliance is understandably poor.
Most of these patients have classic allergic involvement,
ie., allergic rhinitis/sinusitis, asthma, etc., but
it is not clear at this time if aero-allergens contribute
to EE. The role of specific immunotherapy, anti
IgE monoclonal therapy, etc., is not clear and pilot
studies are underway which, hopefully, will add insight.
Until that time, antigen avoidance remains a crucial
part of the treatment of EE.
The physicians and staff of Allergy
& Asthma Specialists, Ltd. would be pleased to
assist you in the care of these patients.
*Spergel
J.A.C.I. 2007 (119) p.504
Ann. All.
& Imm. 2005: (95) p.336
About the
Author
Dr.
Craig S. Koenig
www.allergydocs.net
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