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Vol. 74, No. 1, 2006
Issue release date: November 2006
Digestion 2006;74:49–54

Food Allergies and Eosinophilic Esophagitis – Two Case Studies

Martín-Muñoz M.F. · Lucendo A.J. · Navarro M. · Letrán A. · Martín-Chávarri S. · Burgos E. · Martín-Esteban M.
aAllergy Service, Pediatric Hospital; bGastroenterology Department, and cPathology Department, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain

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Eosinophilic esophagitis (EE) is a clinical-pathological disorder which is being increasingly diagnosed. It is etiologically associated with hypersensitivity to airborne allergens and/or dietary components. However, immediate hypersensitivity to foods has rarely been proven as the etiologic cause of the disorder. Two patients are presented with a history of rhinoconjunctivitis, allergic asthma, atopic dermatitis and food allergies which are currently under control and who show specific IgE to pulses and chicken respectively. These patients developed acute dysphagia and vomiting immediately after ingesting these foods and following appropriate examination were diagnosed as suffering from EE. The study also showed signs of blood hypereosinophilia while the esophageal manometry revealed a motor disorder characterized by aperistalsis and non-propulsive simultaneous waves affecting the lower two-thirds of the organ composed of smooth muscle. Topical treatment with fluticasone propionate was administered over a period of 3 months, in addition to a diet abstaining from the aforementioned foods and this led to remission of dysphagia and normalization of the endoscopic, histological and manometric studies of the esophagus. This situation remained stable for a considerable length of time after steroid treatment was discontinued, which showed that exposure to foods seemed to be the cause of the esophageal disorder. Similarly, allergies to inhalants and other digestive symptoms which appear upon immediate ingestion of the foods involved would not justify the sudden onset of dysphagia. We offer a pathophysiological explanation for the mechanisms of the disease based on the activation of eosinophils and mast cells by IgE and their ability to disturb the dynamic behavior of the neural and muscle components of the esophageal wall.

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  1. Attwood S, Smyrk TC, Demeester TR, Jones JB: Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome. Dig Dis Sci 1993;38:109–116.
  2. Spergel JM, Beausoleil JL, Mascareñas M, Liacouras CA: The use of skin prick test and patch test to identify causative foods in eosinophilic esophagitis. J Allergy Clin Inmunol 2002;109:363–368.
  3. Fox V, Nurko S, Furuta G: Eosinophilic esophagitis: it’s not just kid’s stuff. Gastrointest Endosc 2002;56:260–270.
  4. Faubion WA, Perrault J, Burgart LJ, Zein NN, Clawson ML, Freese DK: Treatment of eosinophilic esophagitis with inhaled corticosteroids. J Pediatr Gastroenterol Nutr 1998;27:90–93.
  5. Sondheimer JM: What are the roles of eosinophils in esophagitis? J Pediatr Gastroenterol Nutr 1998;27:118–119.
  6. Luster AD, Mechanisms of disease. Chemokines: chemotactic cytokines that mediate inflammation. N Engl J Med 1998;338:436–445.
  7. Justinich CJ, Kalafus D, Esposito P, Ricci A Jr, Sylvester FA, Hyams JS et al: Mucosal mast cells distinguish allergic from gastroesophageal reflux induced esophagitis. J Pediatr Gastroenterol Nutr 1996;23:342.

    External Resources

  8. Teitelbaum J, Fox V, Twarog F, Nurko S, Antonioli D, Gleich G et al: Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate. Gastroenterology 2002;122:1216–1225.
  9. Mishra A, Hogan SP, Brandt EB, Rothenberg ME: An etiological role for aeroallergens and eosinophils in experimental esophagitis. J Clin Invest 2001;107:83–90.
  10. Straumann A, Bauer M, Fischer B, Blaser K, Simon HU: Idiopathic eosinophilic esophagitis is associated with a TH2-type allergic inflammatory response. J Allergy Clin Immunol 2001;108:954–961.
  11. Gleich GJ, Kita H: Bronchial asthma: lessons from murine models. Proc Natl Acad Sci USA 1997;94:1101–1102.
  12. Akei HS, Mishra A, Blanchard C, Rothenberg ME: Epicutaneous antigen exposure primes for experimental eosinophilic esophagitis in mice. Gastroenterology 2005;129:985–994.
  13. Mishra A, Hogan SP, Brandt EB, Rothenberg ME: IL-5 promotes eosinophil trafficking to the esophagus. J Immunol 2002;168:2464.
  14. Gupta SK, Fitzgerald JF, Roudratynk T, Hogenesch H: Cytokine expression in normal and inflamed esophageal mucosa: a study into the pathogenesis of allergic eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 2006;42:22–26.
  15. Blanchard C, Wang N, Stringer KF, Mishra A, Fulkerson PC, Abonia JP et al: Eotaxin-3 and a uniquely conserved gene-expression profile in eosinophilic esophagitis. J Clin Invest 2006;116:536–547.
  16. Lucendo AJ, Navarro M, Comas C, Pascual JM, Burgos E, Santamaría L et al: Immunophenotypic characterization and quantification of the epithelial inflammatory infiltrate in eosinophilic esophagitis through stereology. An analysis of the cellular mechanisms of the disease and the immunologic capacity of the esophagus. Am J Surg Pathol 2006 (in press).
  17. Lucendo AJ, Carrión G, Navarro M, Pascual JM, González P, Castillo P et al: Eosinophilic esophagitis in adults: an emerging disease. Dig Dis Sci 2004;49:1884–1888.
  18. Adamko DJ, Odemuyiwa SO, Vethanayagan D, Moqbel R: The rise of the phoenix: the expanding role of the eosinophil in health and disease. Allergy 2005;60:13–22.
  19. Rothenberg ME, Mishra A, Brandt EB, Hogan SP: Gastrointestinal eosinophils. Immunol Rev 2001;179:139–155.

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