Abstract
Background
To our knowledge, in Asia, data on utility of allergy tests in management of eosinophilic esophagitis are lacking. The objective of our study was to determine the role of allergy evaluation in management of Saudi children with eosinophilic esophagitis.
Methods
Children diagnosed as having eosinophilic esophagitis during the period from 2009 to 2012 were referred to an allergist for allergy evaluation. The allergy evaluation consisted of total IgE level, radio-allergosorbent assay, and skin prick test. Depending on the results of the allergy tests, a restricted or elemental diet was established. Swallowed fluticasone inhaler was prescribed to patients who rejected or failed to respond to the diet. Clinical, endoscopic, and histological evaluation was performed in 8 weeks to assess response.
Results
Eighteen children with eosinophilic esophagitis were included (13 males; mean age 5 years, range 1–11). Sensitization to foods was demonstrated in 14 patients: 4 with a positive test for a single food (28.5 %), 1 for 2 food allergens (7 %), and 9 for ≥3 food allergens (64.5 %). The most common food allergens were milk, soybean, wheat, egg, and nuts. Three young children out of the total 14 patients responded to elemental formula. Four of the 10 older children on the allergy testing guided-dietary restriction achieved partial remission and the remaining 6 did not respond. All 10 patients responded to a swallowed fluticasone inhaler.
Conclusion
Although food sensitizations in Saudi children with eosinophilic esophagitis are common, the allergy tests had limited predictive value for the response to dietary elimination.
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References
Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011;128:3–20.
Spergel JM, Beausoleil JL, Mascarenhas M, Liacouras CA. The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol. 2002;109:363–8.
Spergel JM, Andrews T, Brown-Whitehorn TF, Beausoleil JL, Liacouras A. Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests. Ann Allergy Asthma Immunol. 2005;95:336–43.
Mishra A. Mechanism of eosinophilic esophagitis. Immunol Allergy Clin North Am. 2009;29:29–40.
Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007;133:1342–63.
Penfield JD, Lang DM, Goldblum JR, Lopez R, Falk GW. The role of allergy evaluation in adults with eosinophilic esophagitis. J Clin Gastroenterol. 2010;44:22–7.
Erwin EA, James HR, Gutekunst HM, Russo JM, Kelleher KJ, Platts-Mills TA. Serum IgE measurement and detection of food allergy in pediatric patients with eosinophilic esophagitis. Ann Allergy Asthma Immunol. 2010;104:496–502.
CastellanoMdel R, Cimbollek S, Quiralte J. Defining the role of food allergy in a population of adult patients with eosinophilic esophagitis. Inflamm Allergy Drug Targets. 2010;9:257–62.
Spergel JM, Brown-Whitehorn T, Beausoleil JL, Shuker M, Liacouras CA. Predictive values for skin prick test and atopy patch test for eosinophilic esophagitis. J Allergy Clin Immunol. 2007;119:509–11.
Kamdar TA, Ditto AM, Bryce PJ. Skin prick testing does not reflect the presence of IgE against food allergens in adult eosinophilic esophagitis patients: a case study. Clin Mol Immunol. 2010;8:16.
Pascual JMR, De La Hoz Caballer B, Verge CR, Cepeda ST, Ariño GR, López JMR, et al. Allergy assessment in children with eosinophilic esophagitis. J Investig Allergol Clin Immunol. 2011;21(1):59–65.
Al Frayh A, Shakoor Z, Gad ElRab MO, Hasnain SM. Increased prevalence of asthma in Saudi Arabia. Ann Allergy Asthma Immunol. 2001;86:292–6.
Liacouras CA, Spergel JM, Ruchelli E, Verma R, Mascarenhas M, Semeao E, et al. Eosinophilic esophagitis: a 10-year experience in 381 children. Clin Gastroenterol Hepatol. 2005;3:1198–2206.
Noel RJ, Putnam PE, Rothenberg ME. Eosinophilic esophagitis. N Engl J Med. 2004;351:940–1.
Aceves SS, Newbury RO, Dohil R, Bastian JF, Broide DH. Esophageal remodeling in pediatric eosinophilic esophagitis. J Allergy Clin Immunol. 2007;119:206–12.
Markowitz JE, Spergel JM, Ruchelli E, Liacouras CA. Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents. Am J Gastroenterol. 2003;98:777–82.
Henderson CJ, Abonia JP, King EC, Putnam PE, Collins MH, Franciosi JP, et al. Comparative dietary therapy effectiveness in remission of pediatric eosinophilic esophagitis. J Allergy Clin Immunol. 2012;129:1570–8.
Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, et al. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2006;4:1097–102.
Gonsalves N, Yang GY, Doerfler B, Ritz S, Ditto AM, Hirano I. Elimination diet effectively treats eosinophilic esophagitis in adults; food reintroduction identifies causative factors. Gastroenterology. 2012;142:1451–9.
Teitelbaum JE, Fox VL, Twarog FJ, Nurko S, Antonioli D, Gleich G, et al. Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate. Gastroenterology. 2002;122:1216–25.
Simon D, Straumann A, Wenk A, Spichtin H, Simon HU, Braathen LR. Eosinophilic esophagitis in adults: no clinical relevance of wheat and rye sensitizations. Allergy. 2006;61:1480–3.
Mishra A, Rothenberg ME. Intra-tracheal IL-13 induces eosinophilic esophagitis by an IL-5, Eotaxin-1, and STAT6-dependent mechanism. Gastroenterology. 2003;125:1419–27.
Fogg MI, Ruchelli E, Spergel JM. Pollen and eosinophilic esophagitis. J Allergy Clin Immunol. 2003;112:796–7.
Konikoff MR, Noel RJ, Blanchard C, Kirby C, Jameson SC, Buckmeier BK, et al. A randomized, double-blind, placebo-controlled trial of fluticasone propionate for pediatric eosinophilic esophagitis. Gastroenterology. 2006;131:1381–91.
Sugnanam KK, Collins JT, Smith PK, Connor F, Lewindon P, Cleghorn G, et al. Dichotomy of food and inhalant allergen sensitization in eosinophilic esophagitis. Allergy. 2007;62:1257–60.
Arbes SJ Jr, Gergen PJ, Elliott L, Zeldin DC. Prevalences of positive skin test responses to 10 common allergens in the US population: results from the third national health and nutrition examination survey. J Allergy Clin Immunol. 2005;116:377–83.
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Authors disclose that they have no financial relationship to disclose within the past 12 months with biotechnology manufacturers, pharmaceutical companies, or other commercial entity that has any interest in the subject matter, materials, or processes discussed in the manuscript.
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Al-Hussaini, A., Al-Idressi, E. & Al-Zahrani, M. The role of allergy evaluation in children with eosinophilic esophagitis. J Gastroenterol 48, 1205–1212 (2013). https://doi.org/10.1007/s00535-012-0741-6
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DOI: https://doi.org/10.1007/s00535-012-0741-6