Skip to main content

Advertisement

SpringerLink
Log in

Eosinophilic Esophagitis: A Comprehensive Review

  • Published:
Clinical Reviews in Allergy & Immunology Aims and scope Submit manuscript

Abstract

Eosinophilic esophagitis (EoE) is an emerging chronic atopic clinical-pathologic disease with an estimated prevalence of 1/1000 similar to the one of Crohn’s diseases. Usually, EoE is firstly suspected due to symptoms that are caused by esophageal dysfunction and/or fibrosis. EoE diagnosis is confirmed if the esophageal biopsy shows at least 15 eosinophils per high power field (eos/hpf) as a peak value in one or more of at least four specimens obtained randomly from the esophagus. Most of the patients affected by EoE have other atopic diseases such as allergic rhinitis, asthma, IgE-mediated food allergies, and/or atopic dermatitis. The local inflammation is a T helper type 2 (Th2) flogosis, which most likely is driven by a mixed IgE and non-IgE-mediated reaction to food and/or environmental allergens. Recently published genetic studies showed also that EoE is associated with single nucleotide polymorphism (SNP) on genes which are important in atopic inflammation such as thymic stromal lymphopoietin (TSLP) located close to the Th2 cytokine cluster (IL-4, IL-5, IL-13) on chromosome 5q22. When the EoE diagnosis is made, it is imperative to control the local eosinophilic inflammation not only to give symptomatic relief to the patient but also to prevent complications such as esophageal stricture and food impaction. EoE is treated like many other atopic diseases with a combination of topical steroids and/or food antigen avoidance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

APC:

Antigen-presenting cells

CHOP:

The Children’s Hospital of Philadelphia

DC:

Dendritic cells

CAG:

Center for Applied Genomics

CRTH2:

Chemoattractant receptor expressed on Th2 cells

DSG-1:

Desmoglein-1

EGD:

Esophago-gastroduodenal endoscopy

EoE:

Eosinophilic esophagitis

eos:

Eosinophils

GERD:

Gastro-esophageal reflux

hpf:

High power field

IBD:

Inflammatory bowel disease

IL:

Interleukin

iNKT:

Invariant-natural killer cells

LC:

Langerhans cells

PG2:

Prostaglandin D2

PPI:

Proton pump inhibitors

R:

Receptor

SNP:

A small nuclear polymorphism

TNFα:

Tumor necrosis factor alpha

TGFβ:

Transforming growth factor beta

Th2:

T helper type 2

TSLP:

Thymic stromal lymphopoietin

References

  1. Furuta GT, Liacouras CA, Collins MH et al (2007) Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 133:1342–1363

    Article  CAS  PubMed  Google Scholar 

  2. Liacouras CA, Furuta GT, Hirano I (2011) Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 128:3–20, e26

    Article  PubMed  Google Scholar 

  3. Prasad GA, Alexander JA, Schleck CD et al (2009) Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota. Clin Gastroenterol Hepatol 7:1055–1061

    Article  PubMed  PubMed Central  Google Scholar 

  4. Noel RJ, Putnam PE, Rothenberg ME (2004) Eosinophilic esophagitis. N Engl J Med 351:940–941

    Article  CAS  PubMed  Google Scholar 

  5. Straumann A, Simon HU (2005) Eosinophilic esophagitis: escalating epidemiology? J Allergy Clin Immunol 115:418–419

    Article  PubMed  Google Scholar 

  6. Hruz P, Straumann A, Bussmann C et al (2011) Escalating incidence of eosinophilic esophagitis: a 20-year prospective, population-based study in Olten County, Switzerland. J Allergy Clin Immunol 128(1349–1350):e1345

    Google Scholar 

  7. Cherian S, Smith NM, Forbes DA (2006) Rapidly increasing prevalence of eosinophilic oesophagitis in Western Australia. Arch Dis Child 91:1000–1004

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. van Rhijn BD., Verheij J., Smout AJ. and Bredenoord AJ. (2012) Rapidly increasing incidence of eosinophilic esophagitis in a large cohort. Neurogastroenterol Motil

  9. Spergel JM, Brown-Whitehorn TF, Beausoleil JL et al (2009) 14 years of eosinophilic esophagitis: clinical features and prognosis. J Pediatr Gastroenterol Nutr 48:30–36

    Article  PubMed  Google Scholar 

  10. Spergel JM, Brown-Whitehorn TF, Cianferoni A et al (2012) Identification of causative foods in children with eosinophilic esophagitis treated with an elimination diet. J Allergy Clin Immunol 130(461–467):e465

    Google Scholar 

  11. Orenstein SR, Shalaby TM, Di Lorenzo C et al (2000) The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children. Am J Gastroenterol 95:1422–1430

    Article  CAS  PubMed  Google Scholar 

  12. Blanchard C, Wang N, Rothenberg ME (2006) Eosinophilic esophagitis: pathogenesis, genetics, and therapy. J Allergy Clin Immunol 118:1054–1059

    Article  PubMed  Google Scholar 

  13. Blanchard C, Wang N, Stringer KF et al (2006) Eotaxin-3 and a uniquely conserved gene-expression profile in eosinophilic esophagitis. J Clin Invest 116:536–547

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Gupta SK, Fitzgerald JF, Kondratyuk T, HogenEsch H (2006) Cytokine expression in normal and inflamed esophageal mucosa: a study into the pathogenesis of allergic eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 42:22–26

    Article  CAS  PubMed  Google Scholar 

  15. Straumann A, Bauer M, Fischer B, Blaser K, Simon HU (2001) Idiopathic eosinophilic esophagitis is associated with a T (H)2-type allergic inflammatory response. J Allergy Clin Immunol 108:954–961

    Article  CAS  PubMed  Google Scholar 

  16. Straumann A, Kristl J, Conus S et al (2005) Cytokine expression in healthy and inflamed mucosa: probing the role of eosinophils in the digestive tract. Inflamm Bowel Dis 11:720–726

    Article  PubMed  Google Scholar 

  17. Blanchard C, Mingler MK, Vicario M et al (2007) IL-13 involvement in eosinophilic esophagitis: transcriptome analysis and reversibility with glucocorticoids. J Allergy Clin Immunol 120:1292–1300

    Article  CAS  PubMed  Google Scholar 

  18. Blanchard C, Mishra A, Saito-Akei H, Monk P, Anderson I, Rothenberg ME (2005) Inhibition of human interleukin-13-induced respiratory and oesophageal inflammation by anti-human-interleukin-13 antibody (CAT-354). Clin Exp Allergy 35:1096–1103

    Article  CAS  PubMed  Google Scholar 

  19. Blanchard C, Stucke EM, Burwinkel K et al (2010) Coordinate interaction between IL-13 and epithelial differentiation cluster genes in eosinophilic esophagitis. J Immunol 184:4033–4041

    Article  CAS  PubMed  Google Scholar 

  20. Mishra A, Hogan SP, Brandt EB, Rothenberg ME (2002) IL-5 promotes eosinophil trafficking to the esophagus. J Immunol 168:2464–2469

    Article  CAS  PubMed  Google Scholar 

  21. Mishra A, Rothenberg ME (2003) Intratracheal IL-13 induces eosinophilic esophagitis by an IL-5, eotaxin-1, and STAT6-dependent mechanism. Gastroenterology 125:1419–1427

    Article  CAS  PubMed  Google Scholar 

  22. Schmid-Grendelmeier P, Altznauer F, Fischer B et al (2002) Eosinophils express functional IL-13 in eosinophilic inflammatory diseases. J Immunol 169:1021–1027

    Article  CAS  PubMed  Google Scholar 

  23. Levin M, Motala C (2011) Eosinophilic esophagitis in Cape Town, South Africa. Clin Translat Allerg 1:p26

    Article  Google Scholar 

  24. Dellon ES, Jensen ET, Martin CF, Shaheen NJ. and Kappelman MD. (2013) Prevalence of eosinophilic esophagitis in the United States. Clin Gastroenterol Hepatol

  25. Franciosi JP, Tam V, Liacouras CA, Spergel JM (2009) A case–control study of sociodemographic and geographic characteristics of 335 children with eosinophilic esophagitis. Clin Gastroenterol Hepatol 7:415–419

    Article  PubMed  Google Scholar 

  26. Spergel JM, Andrews T, Brown-Whitehorn TF, Beausoleil JL, Liacouras CA (2005) Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests. Ann Allergy Asthma Immunol 95:336–343

    Article  PubMed  Google Scholar 

  27. Collins MH (2008) Histopathologic features of eosinophilic esophagitis. Gastrointest Endosc Clin N Am 18:59–71, viii-ix

    Article  PubMed  Google Scholar 

  28. Dellon ES, Gonsalves N, Hirano I et al (2013) ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol 108:679–692, quiz 693

    Article  PubMed  Google Scholar 

  29. Rothenberg ME, Spergel JM, Sherrill JD et al (2010) Common variants at 5q22 associate with pediatric eosinophilic esophagitis. Nat Genet 42:289–291

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Sherrill JD, Gao PS, Stucke EM et al (2010) Variants of thymic stromal lymphopoietin and its receptor associate with eosinophilic esophagitis. J Allergy Clin Immunol 126(160–165):e163

    Google Scholar 

  31. Blanchard C, Stucke EM, Rodriguez-Jimenez B (2011) A striking local esophageal cytokine expression profile in eosinophilic esophagitis. J Allergy Clin Immunol 127:208–217, 217 e201-207

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Kinoshita Y, Furuta K, Ishimura N, Ishihara S (2012) Elevated plasma cytokines in Japanese patients with eosinophilic esophagitis and gastroenteritis. Digestion 86:238–243

    Article  CAS  PubMed  Google Scholar 

  33. Akei HS, Mishra A, Blanchard C, Rothenberg ME (2005) Epicutaneous antigen exposure primes for experimental eosinophilic esophagitis in mice. Gastroenterology 129:985–994

    Article  CAS  PubMed  Google Scholar 

  34. Merves J, Muir A., Modayur Chandramouleeswaran P, Cianferoni A., Wang ML. and Spergel JM. (2014) Eosinophilic esophagitis. Ann Allergy Asthma Immunol

  35. Muir AB, Lim DM, Benitez AJ et al (2013) Esophageal epithelial and mesenchymal cross-talk leads to features of epithelial to mesenchymal transition in vitro. Exp Cell Res 319:850–859

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Wenzel SE, Schwartz LB, Langmack EL et al (1999) Evidence that severe asthma can be divided pathologically into two inflammatory subtypes with distinct physiologic and clinical characteristics. Am J Respir Crit Care Med 160:1001–1008

    Article  CAS  PubMed  Google Scholar 

  37. Mishra A, Wang M, Pemmaraju VR et al (2008) Esophageal remodeling develops as a consequence of tissue specific IL-5-induced eosinophilia. Gastroenterology 134:204–214

    Article  PubMed  PubMed Central  Google Scholar 

  38. Pope SM, Brandt EB, Mishra A et al (2001) IL-13 induces eosinophil recruitment into the lung by an IL-5- and eotaxin-dependent mechanism. J Allergy Clin Immunol 108:594–601

    Article  CAS  PubMed  Google Scholar 

  39. Mishra A, Hogan SP, Brandt EB et al (2002) Enterocyte expression of the eotaxin and interleukin-5 transgenes induces compartmentalized dysregulation of eosinophil trafficking. J Biol Chem 277:4406–4412

    Article  CAS  PubMed  Google Scholar 

  40. Spergel JM, Rothenberg ME, Collins MH (2012) Reslizumab in children and adolescents with eosinophilic esophagitis: results of a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol 129:456–463, 463 e451-453

    Article  CAS  PubMed  Google Scholar 

  41. Assa’ad AH, Gupta SK, Collins MH et al (2011) An antibody against IL-5 reduces numbers of esophageal intraepithelial eosinophils in children with eosinophilic esophagitis. Gastroenterology 141:1593–1604

    Article  PubMed  CAS  Google Scholar 

  42. Li M, Hener P, Zhang Z, Ganti KP, Metzger D, Chambon P (2009) Induction of thymic stromal lymphopoietin expression in keratinocytes is necessary for generating an atopic dermatitis upon application of the active vitamin D3 analogue MC903 on mouse skin. J Invest Dermatol 129:498–502

    Article  CAS  PubMed  Google Scholar 

  43. Soumelis V, Reche PA, Kanzler H et al (2002) Human epithelial cells trigger dendritic cell mediated allergic inflammation by producing TSLP. Nat Immunol 3:673–680

    Article  CAS  PubMed  Google Scholar 

  44. Noti M., Wojno ED., Kim BS., et al. (2013) Thymic stromal lymphopoietin-elicited basophil responses promote eosinophilic esophagitis. Nat Med

  45. Siracusa MC, Kim BS, Spergel JM, Artis D (2013) Basophils and allergic inflammation. J Allergy Clin Immunol 132:789–801, quiz 788

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Siracusa MC, Saenz SA, Hill DA et al (2011) TSLP promotes interleukin-3-independent basophil haematopoiesis and type 2 inflammation. Nature 477:229–233

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Wojno EDT, Noti M, Kim BS et al (2013) TSLP-elicited basophil responses mediate the pathogenesis of eosinophilic esophagitis. Cytokine 63:310–310

    Article  Google Scholar 

  48. Noti M, Wojno ED, Kim BS et al (2013) Thymic stromal lymphopoietin-elicited basophil responses promote eosinophilic esophagitis. Nat Med 19:1005–1013

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Blanchard C, Durual S, Estienne M, Emami S, Vasseur S, Cuber JC (2005) Eotaxin-3/CCL26 gene expression in intestinal epithelial cells is up-regulated by interleukin-4 and interleukin-13 via the signal transducer and activator of transcription 6. Int J Biochem Cell Biol 37:2559–2573

    Article  CAS  PubMed  Google Scholar 

  50. Cheng E, Zhang X, Huo X et al (2013) Omeprazole blocks eotaxin-3 expression by oesophageal squamous cells from patients with eosinophilic oesophagitis and GORD. Gut 62:824–832

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Johnsson M, Bove M, Bergquist H et al (2011) Distinctive blood eosinophilic phenotypes and cytokine patterns in eosinophilic esophagitis, inflammatory bowel disease and airway allergy. J Innate Immun 3:594–604

    Article  CAS  PubMed  Google Scholar 

  52. Sherrill J. D., Kc K., Wu D., et al. (2013) Desmoglein-1 regulates esophageal epithelial barrier function and immune responses in eosinophilic esophagitis. Mucosal Immunol

  53. Wen T, Stucke EM, Grotjan TM et al (2013) Molecular diagnosis of eosinophilic esophagitis by gene expression profiling. Gastroenterology 145:1289–1299

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Yen EH, Hornick JL, Dehlink E et al (2010) Comparative analysis of FcepsilonRI expression patterns in patients with eosinophilic and reflux esophagitis. J Pediatr Gastroenterol Nutr 51:584–592

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Lim DM, Narasimhan S, Michaylira CZ, Wang ML (2009) TLR3-mediated NF-{kappa}B signaling in human esophageal epithelial cells. Am J Physiol Gastrointest Liver Physiol 297:G1172–G1180

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Mulder DJ, Lobo D, Mak N, Justinich CJ (2012) Expression of toll-like receptors 2 and 3 on esophageal epithelial cell lines and on eosinophils during esophagitis. Dig Dis Sci 57:630–642

    Article  CAS  PubMed  Google Scholar 

  57. Jyonouchi S., Smith CL., Saretta F., et al. (2013) Invariant natural killer T cells in children with eosinophilic esophagitis. Clin Exp Allergy

  58. Mulder DJ, Pooni A, Mak N, Hurlbut DJ, Basta S, Justinich CJ (2011) Antigen presentation and MHC class II expression by human esophageal epithelial cells: role in eosinophilic esophagitis. Am J Pathol 178:744–753

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Straumann A, Conus S, Grzonka P et al (2010) Anti-interleukin-5 antibody treatment (mepolizumab) in active eosinophilic oesophagitis: a randomised, placebo-controlled, double-blind trial. Gut 59:21–30

    Article  CAS  PubMed  Google Scholar 

  60. Spergel JM, Rothenberg ME, Collins MH (2012) Reslizumab in children and adolescents with eosinophilic esophagitis: results of a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol 129:456–463, 463 e451-453

    Article  CAS  PubMed  Google Scholar 

  61. Rajavelu P, Rayapudi M, Moffitt M, Mishra A, Mishra A (2012) Significance of para-esophageal lymph nodes in food or aeroallergen-induced iNKT cell-mediated experimental eosinophilic esophagitis. Am J Physiol Gastrointest Liver Physiol 302:G645–G654

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Mishra A, Schlotman J, Wang M, Rothenberg ME (2007) Critical role for adaptive T cell immunity in experimental eosinophilic esophagitis in mice. J Leukoc Biol 81:916–924

    Article  CAS  PubMed  Google Scholar 

  63. Yamazaki K, Murray JA, Arora AS et al (2006) Allergen-specific in vitro cytokine production in adult patients with eosinophilic esophagitis. Dig Dis Sci 51:1934–1941

    Article  CAS  PubMed  Google Scholar 

  64. Abonia JP, Blanchard C, Butz BB et al (2010) Involvement of mast cells in eosinophilic esophagitis. J Allergy Clin Immunol 126:140–149

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Crockett SD, Sperry SL, Miller CB, Shaheen NJ, Dellon ES (2013) Emergency care of esophageal foreign body impactions: timing, treatment modalities, and resource utilization. Dis Esophagus 26:105–112

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Desai TK, Stecevic V, Chang CH, Goldstein NS, Badizadegan K, Furuta GT (2005) Association of eosinophilic inflammation with esophageal food impaction in adults. Gastrointest Endosc 61:795–801

    Article  PubMed  Google Scholar 

  67. Aceves SS, Ackerman SJ (2009) Relationships between eosinophilic inflammation, tissue remodeling, and fibrosis in eosinophilic esophagitis. Immunol Allergy Clin North Am 29:197–211, xiii-xiv

    Article  PubMed  PubMed Central  Google Scholar 

  68. Tomasek JJ, Gabbiani G, Hinz B, Chaponnier C, Brown RA (2002) Myofibroblasts and mechano-regulation of connective tissue remodelling. Nat Rev Mol Cell Biol 3:349–363

    Article  CAS  PubMed  Google Scholar 

  69. Kagalwalla AF, Akhtar N, Woodruff SA et al (2012) Eosinophilic esophagitis: epithelial mesenchymal transition contributes to esophageal remodeling and reverses with treatment. J Allergy Clin Immunol 129(1387–1396):e1387

    Article  CAS  Google Scholar 

  70. Aceves SS, Newbury RO, Chen D et al (2010) Resolution of remodeling in eosinophilic esophagitis correlates with epithelial response to topical corticosteroids. Allergy 65:109–116

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Aceves SS, Newbury RO, Dohil R, Bastian JF, Broide DH (2007) Esophageal remodeling in pediatric eosinophilic esophagitis. J Allergy Clin Immunol 119:206–212

    Article  CAS  PubMed  Google Scholar 

  72. Kottyan LC, Davis BP, Sherrill JD et al (2014) Genome-wide association analysis of eosinophilic esophagitis provides insight into the tissue specificity of this allergic disease. Nat Genet 46:895–900

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Lal G, Bromberg JS (2009) Epigenetic mechanisms of regulation of Foxp3 expression. Blood 114:3727–3735

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Schmidl C, Hansmann L, Lassmann T et al (2014) The enhancer and promoter landscape of human regulatory and conventional T-cell subpopulations. Blood 123:e68–e78

    Article  CAS  PubMed  Google Scholar 

  75. He H, Ni B, Tian Y et al (2014) Histone methylation mediates plasticity of human FOXP3(+) regulatory T cells by modulating signature gene expressions. Immunology 141:362–376

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Tian Y, Jia Z, Wang J et al (2011) Global mapping of H3K4me1 and H3K4me3 reveals the chromatin state-based cell type-specific gene regulation in human Treg cells. PLoS One 6:e27770

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Lim EJ, Lu TX, Blanchard C, Rothenberg ME (2011) Epigenetic regulation of the IL-13-induced human eotaxin-3 gene by CREB-binding protein-mediated histone 3 acetylation. J Biol Chem 286:13193–13204

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Zhang X, Cheng E, Huo X et al (2012) Omeprazole blocks STAT6 binding to the eotaxin-3 promoter in eosinophilic esophagitis cells. PLoS One 7:e50037

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  79. Lim E, Rothenberg ME (2014) Demethylation of the human eotaxin-3 gene promoter leads to the elevated expression of eotaxin-3. J Immunol 192:466–474

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Lu TX, Rothenberg ME (2013) Diagnostic, functional, and therapeutic roles of microRNA in allergic diseases. J Allergy Clin Immunol 132:3–13

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  81. Kelly KJ, Lazenby AJ, Rowe PC, Yardley JH, Perman JA, Sampson HA (1995) Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology 109:1503–1512

    Article  CAS  PubMed  Google Scholar 

  82. Kagalwalla AF, Sentongo TA, Ritz S et al (2006) Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol 4:1097–1102

    Article  PubMed  Google Scholar 

  83. Gonsalves N (2007) Food allergies and eosinophilic gastrointestinal illness. Gastroenterol Clin North Am 36(75–91):vi

    Google Scholar 

  84. Kagalwalla AF, Shah A, Li BU et al (2011) Identification of specific foods responsible for inflammation in children with eosinophilic esophagitis successfully treated with empiric elimination diet. J Pediatr Gastroenterol Nutr 53:145–149

    Article  CAS  PubMed  Google Scholar 

  85. Wang FY, Gupta SK, Fitzgerald JF (2007) Is there a seasonal variation in the incidence or intensity of allergic eosinophilic esophagitis in newly diagnosed children? J Clin Gastroenterol 41:451–453

    Article  PubMed  Google Scholar 

  86. Sugnanam KK, Collins JT, Smith PK et al (2007) Dichotomy of food and inhalant allergen sensitization in eosinophilic esophagitis. Allergy 62:1257–1260

    Article  CAS  PubMed  Google Scholar 

  87. Rocha R, Vitor AB, Trindade E et al (2011) Omalizumab in the treatment of eosinophilic esophagitis and food allergy. Euro J Pediatr 170:1471–1474

    Article  CAS  Google Scholar 

  88. Maggadottir SM, Hill DA, Ruymann K (2014) Resolution of acute IgE-mediated allergy with development of eosinophilic esophagitis triggered by the same food. J Allergy Clin Immunol 133:1487–1489, 1489 e1481

    Article  CAS  PubMed  Google Scholar 

  89. Ridolo E, De Angelis GL, Dall’aglio P (2011) Eosinophilic esophagitis after specific oral tolerance induction for egg protein. Ann Allergy Asthma Immunol 106:73–74

    Article  PubMed  Google Scholar 

  90. Liacouras CA, Furuta GT, Hirano I et al (2011) Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 128(3–20):e26, quiz 21–22

    Google Scholar 

  91. Rothenberg ME, Aceves S, Bonis PA et al (2012) Working with the US Food and Drug Administration: progress and timelines in understanding and treating patients with eosinophilic esophagitis. J Allergy Clin Immunol 130:617–619

    Article  PubMed  Google Scholar 

  92. Gonsalves N, Yang GY, Doerfler B, Ritz S, Ditto AM, Hirano I (2012) Elimination diet effectively treats eosinophilic esophagitis in adults; food reintroduction identifies causative factors. Gastroenterology 142:1451–1459, e1451; quiz e1414-1455

    Article  PubMed  Google Scholar 

  93. Liacouras CA, Spergel JM, Ruchelli E et al (2005) Eosinophilic esophagitis: a 10-year experience in 381 children. Clin Gastroenterol Hepatol 3:1198–1206

    Article  PubMed  Google Scholar 

  94. Konikoff MR, Noel RJ, Blanchard C et al (2006) A randomized, double-blind, placebo-controlled trial of fluticasone propionate for pediatric eosinophilic esophagitis. Gastroenterology 131:1381–1391

    Article  CAS  PubMed  Google Scholar 

  95. Noel RJ, Putnam PE, Collins MH et al (2004) Clinical and immunopathologic effects of swallowed fluticasone for eosinophilic esophagitis. Clin Gastroenterol Hepatol 2:568–575

    Article  CAS  PubMed  Google Scholar 

  96. Teitelbaum JE, Fox VL, Twarog FJ et al (2002) Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate. Gastroenterology 122:1216–1225

    Article  CAS  PubMed  Google Scholar 

  97. Caldwell JM, Blanchard C, Collins MH et al (2010) Glucocorticoid-regulated genes in eosinophilic esophagitis: a role for FKBP51. J Allergy Clin Immunol 125(879–888):e878

    Google Scholar 

  98. Aceves SS, Bastian JF, Newbury RO, Dohil R (2007) Oral viscous budesonide: a potential new therapy for eosinophilic esophagitis in children. Am J Gastroenterol 102:2271–2279, quiz 2280

    Article  CAS  PubMed  Google Scholar 

  99. Dohil R, Newbury R, Fox L, Bastian J, Aceves S (2010) Oral viscous budesonide is effective in children with eosinophilic esophagitis in a randomized, placebo-controlled trial. Gastroenterology 139:418–429

    Article  CAS  PubMed  Google Scholar 

  100. Schaefer ET, Fitzgerald JF, Molleston JP et al (2008) Comparison of oral prednisone and topical fluticasone in the treatment of eosinophilic esophagitis: a randomized trial in children. Clin Gastroenterol Hepatol 6:165–173

    Article  CAS  PubMed  Google Scholar 

  101. Alexander JA, Jung KW, Arora AS et al (2012) Swallowed fluticasone improves histologic but not symptomatic response of adults with eosinophilic esophagitis. Clin Gastroenterol Hepatol 10(742–749):e741

    Google Scholar 

  102. Straumann A, Conus S, Degen L (2010) Budesonide is effective in adolescent and adult patients with active eosinophilic esophagitis. Gastroenterology 139:1526–1537, 1537 e1521

    Article  CAS  PubMed  Google Scholar 

  103. Dellon ES, Sheikh A, Speck O et al (2012) Viscous topical is more effective than nebulized steroid therapy for patients with eosinophilic esophagitis. Gastroenterology 143(321–324):e321

    Article  CAS  Google Scholar 

  104. Lucendo AJ, Arias A, De Rezende LC et al (2011) Subepithelial collagen deposition, profibrogenic cytokine gene expression, and changes after prolonged fluticasone propionate treatment in adult eosinophilic esophagitis: a prospective study. J Allergy Clin Immunol 128:1037–1046

    Article  CAS  PubMed  Google Scholar 

  105. Kelly HW, Sternberg AL, Lescher R et al (2012) Effect of inhaled glucocorticoids in childhood on adult height. N Engl J Med 367:904–912

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  106. Turpeinen M, Pelkonen AS, Nikander K et al (2010) Bone mineral density in children treated with daily or periodical inhaled budesonide: the Helsinki Early Intervention Childhood Asthma study. Pediatr Res 68:169–173

    Article  CAS  PubMed  Google Scholar 

  107. Spergel JM (2007) Eosinophilic esophagitis in adults and children: evidence for a food allergy component in many patients. Curr Opin Allergy Clin Immunol 7:274–278

    Article  PubMed  Google Scholar 

  108. Spergel JM, Beausoleil JL, Mascarenhas M, Liacouras CA (2002) The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol 109:363–368

    Article  PubMed  Google Scholar 

  109. Spergel JM, Brown-Whitehorn T (2005) The use of patch testing in the diagnosis of food allergy. Curr Allerg Asthma Rep 5:86–90

    Article  Google Scholar 

  110. Simon D, Marti H, Heer P, Simon HU, Braathen LR, Straumann A (2005) Eosinophilic esophagitis is frequently associated with IgE-mediated allergic airway diseases. J Allergy Clin Immunol 115:1090–1092

    Article  PubMed  Google Scholar 

  111. Spergel JM, Brown-Whitehorn T, Beausoleil JL, Shuker M, Liacouras CA (2007) Predictive values for skin prick test and atopy patch test for eosinophilic esophagitis. J Allergy Clin Immunol 119:509–511

    Article  PubMed  Google Scholar 

  112. Kalach N, Soulaines P, de Boissieu D, Dupont C (2005) A pilot study of the usefulness and safety of a ready-to-use atopy patch test (Diallertest) versus a comparator (Finn Chamber) during cow’s milk allergy in children. J Allergy Clin Immunol 116:1321–1326

    Article  PubMed  Google Scholar 

  113. Isolauri E, Turjanmaa K (1996) Combined skin prick and patch testing enhances identification of food allergy in infants with atopic dermatitis. J Allergy Clin Immunol 97:9–15

    Article  CAS  PubMed  Google Scholar 

  114. Kekki OM, Turjanmaa K, Isolauri E (1997) Differences in skin-prick and patch-test reactivity are related to the heterogeneity of atopic eczema in infants. Allergy 52:755–759

    Article  CAS  PubMed  Google Scholar 

  115. Rance F (2004) What is the optimal occlusion time for the atopy patch test in the diagnosis of food allergies in children with atopic dermatitis? Pediatr Allergy Immunol 15:93–96

    Article  PubMed  Google Scholar 

  116. Greenhawt MJ, Aceves S, Spergel JM, Rothenberg ME (2013) The management of eosinophilic esophagitis. J Allergy Clin Immunol: In Practice 1:332–340

    Article  Google Scholar 

  117. Spergel JM, Shuker M (2008) Nutritional management of eosinophilic esophagitis. Gastrointest Endosc Clin N Am 18:179–194, xi

    Article  PubMed  Google Scholar 

  118. Hart TK, Cook RM, Zia-Amirhosseini P et al (2001) Preclinical efficacy and safety of mepolizumab (SB-240563), a humanized monoclonal antibody to IL-5, in cynomolgus monkeys. J Allergy Clin Immunol 108:250–257

    Article  CAS  PubMed  Google Scholar 

  119. Egan RW, Athwal D, Bodmer MW et al (1999) Effect of Sch 55700, a humanized monoclonal antibody to human interleukin-5, on eosinophilic responses and bronchial hyperreactivity. Arzneimittelforschung 49:779–790

    CAS  PubMed  Google Scholar 

  120. Conus S, Straumann A, Bettler E, Simon HU (2010) Mepolizumab does not alter levels of eosinophils, T cells, and mast cells in the duodenal mucosa in eosinophilic esophagitis. J Allergy Clin Immunol 126:175–177

    Article  CAS  PubMed  Google Scholar 

  121. Straumann A, Bussmann C, Conus S, Beglinger C, Simon HU (2008) Anti-TNF-alpha (infliximab) therapy for severe adult eosinophilic esophagitis. J Allergy Clin Immunol 122:425–427

    Article  CAS  PubMed  Google Scholar 

  122. Rocha R, Vitor AB, Trindade E et al (2011) Omalizumab in the treatment of eosinophilic esophagitis and food allergy. Eur J Pediatr 170:1471–1474

    Article  CAS  PubMed  Google Scholar 

  123. Straumann A, Hoesli S, Bussmann C et al (2013) Anti-eosinophil activity and clinical efficacy of the CRTH2 antagonist OC000459 in eosinophilic esophagitis. Allergy 68:375–385

    Article  CAS  PubMed  Google Scholar 

  124. Nelson HS, Lahr J, Rule R, Bock A, Leung D (1997) Treatment of anaphylactic sensitivity to peanuts by immunotherapy with injections of aqueous peanut extract. J Allergy Clin Immunol 99:744–751

    Article  CAS  PubMed  Google Scholar 

  125. Nowak-Wegrzyn A, Sampson HA (2011) Future therapies for food allergies. J Allergy Clin Immunol 127:558–573, quiz 574–555

    Article  PubMed  PubMed Central  Google Scholar 

  126. Jones SM, Pons L, Roberts JL (2009) Clinical efficacy and immune regulation with peanut oral immunotherapy. J Allergy Clin Immunol 124:292–300, 300 e291-297

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  127. Buchanan AD, Green TD, Jones SM et al (2007) Egg oral immunotherapy in nonanaphylactic children with egg allergy. J Allergy Clin Immunol 119:199–205

    Article  CAS  PubMed  Google Scholar 

  128. Patriarca G, Nucera E, Pollastrini E et al (2007) Oral specific desensitization in food-allergic children. Dig Dis Sci 52:1662–1672

    Article  PubMed  Google Scholar 

  129. Patriarca G, Schiavino D, Nucera E, Schinco G, Milani A, Gasbarrini GB (1998) Food allergy in children: results of a standardized protocol for oral desensitization. Hepatogastroenterology 45:52–58

    CAS  PubMed  Google Scholar 

  130. Skripak JM, Nash SD, Rowley H et al (2008) A randomized, double-blind, placebo-controlled study of milk oral immunotherapy for cow’s milk allergy. J Allergy Clin Immunol 122:1154–1160

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  131. Hofmann AM, Scurlock AM, Jones SM (2009) Safety of a peanut oral immunotherapy protocol in children with peanut allergy. J Allergy Clin Immunol 124:286–291, 291 e281-286

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  132. Narisety SD, Skripak JM, Steele P et al (2009) Open-label maintenance after milk oral immunotherapy for IgE-mediated cow’s milk allergy. J Allergy Clin Immunol 124:610–612

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  133. Sanchez-Garcia S, Rodriguez Del Rio P, Escudero C, Martinez-Gomez MJ, Ibanez MD (2012) Possible eosinophilic esophagitis induced by milk oral immunotherapy. J Allergy Clin Immunol 129:1155–1157

    Article  PubMed  Google Scholar 

  134. Onbasi K, Sin AZ, Doganavsargil B, Onder GF, Bor S, Sebik F (2005) Eosinophil infiltration of the oesophageal mucosa in patients with pollen allergy during the season. Clin Exp Allergy 35:1423–1431

    Article  CAS  PubMed  Google Scholar 

  135. De Swert L, Veereman G, Bublin M et al (2013) Eosinophilic gastrointestinal disease suggestive of pathogenesis-related class 10 (PR-10) protein allergy resolved after immunotherapy. J Allergy Clin Immunol 131(600–602):e601–e603

    Google Scholar 

  136. Ramirez R. M. and Jacobs RL. (2013) Eosinophilic esophagitis treated with immunotherapy to dust mites. J Allergy Clin Immunol

Download references

Funding

Institutional Support from The Department of Pediatrics, The Children’s Hospital of Philadelphia, and Joint Center for Gastroenterology and Nutrition of CHOP-HUP, and The CHOP Food Allergy Family Research Fund

Conflict of Interest

None

Author information

Authors and Affiliations

  1. Division of Allergy and Immunology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Antonella Cianferoni & Jonathan Spergel

  2. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Antonella Cianferoni & Jonathan Spergel

Authors
  1. Antonella Cianferoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonathan Spergel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antonella Cianferoni.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cianferoni, A., Spergel, J. Eosinophilic Esophagitis: A Comprehensive Review. Clinic Rev Allerg Immunol 50, 159–174 (2016). https://doi.org/10.1007/s12016-015-8501-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12016-015-8501-z

Keywords

Search

Navigation