Etio Pathogenesis of Autoimmunity

Immunologic Research

, Volume 56, Issue 2, pp 249-260

First online:

Eosinophilic esophagitis: an immune-mediated esophageal disease

  • Jenny Weinbrand-GoichbergAffiliated withPediatric Department, E. Wolfson Medical Center
  • , Idit SegalAffiliated withPediatric Gastroenterology and Nutrition Unit, E. Wolfson Medical Center
  • , Adi OvadiaAffiliated withPediatric Department, E. Wolfson Medical Center
  • , Arie LevineAffiliated withPediatric Gastroenterology and Nutrition Unit, E. Wolfson Medical CenterSackler School of Medicine, Tel Aviv University
  • , Ilan DalalAffiliated withPediatric Allergy and Immunology Unit, E. Wolfson Medical CenterSackler School of Medicine, Tel Aviv University Email author 

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Abstract

Eosinophilic esophagitis (EoE) is an emerging disease defined by esophageal dysfunction, by typical endoscopic findings and by abnormal eosinophilic inflammation within the esophagus. Eosinophilic accumulation in the esophagus occurs as a result of esophageal overexpression of pro-inflammatory mediators, including T cells and mast cells, cytokines such as interleukin (IL)-13, IL-5 and IL-15, as well as chemoattractants (eotaxin and transforming growth factor-β1, fibroblast growth factor and the newly characterized gene—thymic stromal lymphopoietin, which is a key regulator of allergic sensitization initiation). The role of allergy, particularly food allergy in EoE is indisputable, as elimination diet is a proven commonly used treatment for the disease. However, unlike classical immediate IgE-mediated reaction to allergen, EoE is associated with an altered immune response, characterized by a combination of IgE-mediated and non-IgE-mediated mechanisms. In this review, we aim to discuss the many typical aspects of EoE as opposed to other entities involving the esophagus, with focusing on the aberrant immune-mediated key players contributing to the pathogenesis of this unique disease.

Keywords

Esophagitis Eosinophilic inflammation Mix IgE and non-IgE mediated Food allergy Elimination diet Eotaxin-3