EoE Module 10 References-Greuter et al J Allergy Clin Immunol 2020 Emerging therapies for eosinophilic esophagitis

Greuter et al J Allergy Clin Immunol 2020 Emerging therapies for eosinophilic esophagitis

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Eosinophilic esophagitis (EoE) is a chronic immune disorder characterized by esophageal inflammation, mainly involving eosinophil infiltration. Although the U.S. FDA has not yet approved a specific treatment for EoE, current off-label management strategies include the use of swallowed topical corticosteroids, dietary restrictions, and esophageal dilation to alleviate symptoms.<br /><br />Recent advancements have led to the development of EoE-specific steroid formulations aimed at enhancing mucosal deposition, like the budesonide effervescent tablet, which is approved in Europe. In addition, new biologic treatments, primarily used in other TH2-mediated conditions such as allergic asthma, are being trialed for EoE. These target inflammatory pathways involving cytokines such as IL-4, IL-5, and IL-13.<br /><br />Swallowed topical corticosteroids remain a mainstay for treating EoE due to their capability to reverse key pathogenic mechanisms like esophageal eosinophilia and mast cell infiltration. Improvements in steroid formulations focus on increasing mucosal contact time and simplifying administration, which recent trials have shown to be effective in achieving clinical and histological remission.<br /><br />Biologic therapies show promise, particularly for steroid-refractory patients or those with multiple atopic conditions, although the need for maintenance treatment and concerns about long-term efficacy remain. Trials investigating biologics like benralizumab, RPC4046, and dupilumab (which targets both IL-4 and IL-13) have demonstrated favorable outcomes in reducing inflammation and symptoms.<br /><br />Novel dietary approaches, such as the step-up elimination diet, are also being explored to identify and restrict trigger foods more efficiently while minimizing dietary burden on patients. Overall, the future of EoE treatment appears promising with these emerging therapies offering more targeted and personalized management options.

Keywords

Eosinophilic esophagitis

immune disorder

esophageal inflammation

topical corticosteroids

dietary restrictions

biologic treatments

inflammatory pathways

cytokines

budesonide

elimination diet