Eosinophilic Esophagitis: Allergic Contribution, Testing, and Management

Both basic science and clinical data indicate a strong role for allergy as a cause of eosinophilic esophagitis. As a result, one of the desired goals of therapy is identification and elimination of food antigens that trigger the allergic inflammatory pathway. Traditional methods for identification o...

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Bibliographic Details
Published in:Current gastroenterology reports 2012-06, Vol.14 (3), p.206-215
Main Authors: Arora, Amindra A., Weiler, Catherine R., Katzka, David A.
Format: Article
Language:English
Subjects:
Allergens
Allergies
Antigens
Cells
Cytokines
Eosinophilic Esophagitis - immunology
Eosinophilic Esophagitis - therapy
Epigenetics
Esophagus
Esophagus (MF Vela
Evidence-Based Medicine - methods
Food
Food Hypersensitivity - complications
Food Hypersensitivity - diagnosis
Food Hypersensitivity - therapy
Gastroenterology
Humans
Immunologic Tests
Investigations
Medicine
Medicine & Public Health
Pathogenesis
Proteins
Section Editor
Skin
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Summary:Both basic science and clinical data indicate a strong role for allergy as a cause of eosinophilic esophagitis. As a result, one of the desired goals of therapy is identification and elimination of food antigens that trigger the allergic inflammatory pathway. Traditional methods for identification of causative food antigens include induction of symptoms with exposure to the antigen, demonstration of serum IgE antibodies against antigens and induction of immediate (IgE) or delayed (Th2) reactions against dermal instillation of antigens. Although some data support the use of these tests in patients with eosinophilic esophagitis, they are limited in this disease. This limitation results from an inability to provoke recognizable symptoms and a lack of concordance between allergies identified in the skin and the blood with the antigens that trigger esophageal disease. As a result, allergy therapy in eosinophilic esophagitis consists of global elimination of food antigens with an elemental diet or exclusion of the most common antigens. As compliance is difficult with these strategies, the mainstay of allergy therapy in eosinophilic esophagitis has become the use of medications that blunt the allergic pathway such as steroids with a future aimed toward more specific inhibitors of this pathway in eosinophilic esophagitis specifically.
ISSN:1522-8037
1534-312X
DOI:10.1007/s11894-012-0254-8