EoE ToT Module 4 References-Cafone et al Curr Opin Allergy Clin Immunol 2016 EoE during sublingual and oral allergen immunotherapy

Cafone et al Curr Opin Allergy Clin Immunol 2016 EoE during sublingual and oral allergen immunotherapy

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The document is a review article discussing the relationship between eosinophilic esophagitis (EoE) and allergen immunotherapy, specifically oral (OIT) and sublingual (SLIT) methods. EoE is a chronic inflammatory condition of the esophagus, triggered by allergens, and characterized by esophageal dysfunction and symptoms like abdominal pain, reflux, and dysphagia. This condition can lead to serious complications if untreated.<br /><br />The review aims to outline the incidence and risks of developing EoE in patients undergoing immunotherapy for food and environmental allergies. Evidence shows that patients receiving OIT, particularly for peanut, milk, and egg allergies, can develop EoE, with varying degrees of incidence and severity. For instance, the Petroni meta-analysis revealed OIT-induced EoE incidences of around 5.3% in patients across multiple studies. New studies support these findings, showing that symptoms suggestive of EoE often lead to the discontinuation of OIT, although confirmatory endoscopies are infrequent.<br /><br />Similarly, SLIT for aeroallergens like grass, dust mites, and tree pollen has also been associated with EoE development. Case reports indicate that the development of EoE during SLIT can happen both during up-dosing and maintenance phases but tends to resolve upon discontinuing therapy and initiating treatments like proton pump inhibitors (PPIs).<br /><br />The review points out critical gaps, including the need for more studies to determine the long-term outcomes of patients with immunotherapy-associated EoE and better diagnostic strategies to accurately estimate its incidence. Moreover, it calls for a deeper understanding of the immunologic mechanisms underlying such side effects to improve patient management and treatment protocols.<br /><br />Conclusively, while allergen immunotherapy shows promise for managing IgE-mediated food allergies, it also poses a significant risk for EoE, necessitating cautious clinical approaches and further research for safer therapeutic options.

Keywords

eosinophilic esophagitis

allergen immunotherapy

oral immunotherapy

sublingual immunotherapy

food allergies

environmental allergies

OIT-induced EoE

SLIT-induced EoE

proton pump inhibitors

immunologic mechanisms