Syrigou Ekaterini, Angelakopoulou Aspasia, Zande Maria, Panagiotou Ioanna, Roma Eleftheria, Pitsios Constantinos
Allergy Department, 'Sotiria' General Hospital, Athens, Greece.
First Department of Paediatrics, University of Athens, Athens, Greece.
Pediatr Allergy Immunol. 2015 Jun;26(4):323-9. doi: 10.1111/pai.12389.
A combination of PPIs and corticosteroids is the pharmacotherapy mostly used to treat eosinophilic esophagitis (EoE), while dietetic manipulations consist also an efficient option. The aim of this study was to compare the efficacy of allergy-test-driven elimination diet in children with mild symptoms of EoE to a group of children with moderate/severe symptoms.
Thirty-five children, aged 7 months to 12 yr, with EoE were enrolled in the study. They had a clinical history of GERD-like (21 children, Group A) or more severe symptoms (14 children, Group B). The diagnosis had been confirmed after two preliminary months of therapy with PPIs and an esophagogastroduodenoscopy. Soon after diagnosis, they were allergy-tested, using IgE detection (SPT and serum-specific IgE) and atopy patch tests (APTs). A 12-month tailor-made diet was prescribed according to the tests. Patients of Group B continued PPIs for two more months, while swallowed topical steroids were also prescribed to them for the first 5 months after diagnosis, followed by an 'as-needed' use of them for the rest of the study. Endoscopy was repeated at the end of the study.
Milk and egg were the most common APT-positive allergens. Thirty-two patients were instructed to follow an elimination diet, which was completed by 15/18 of Group A and 12/14 of Group B. An improvement of symptoms was reported by 26/27 patients that completed the study. The use of swallowed corticosteroids was noticeably decreased during the as-needed period, in Group B. A remarkable reduce of eosinophils was noticed in biopsies; from 42.84 ± 18.08, they decreased to 6.41 ± 3.20, a year after.
All children with EoE and mild symptoms had resolution of symptoms and normal eosinophils in the esophageal mucosa a year after an allergy-driven elimination diet. Patients with moderate/severe EoE symptoms had the same improvement, indicating that an elimination diet is an efficient complementary treatment to corticosteroids.
质子泵抑制剂（PPI）与皮质类固醇的联合使用是治疗嗜酸性食管炎（EoE）最常用的药物疗法，而饮食调整也是一种有效的选择。本研究的目的是比较针对轻度症状的EoE儿童采用过敏测试驱动的排除饮食与针对中度/重度症状儿童的疗效。
35名年龄在7个月至12岁的EoE儿童纳入本研究。他们有胃食管反流病样临床病史（21名儿童，A组）或更严重症状（14名儿童，B组）。在使用PPI进行两个月的初步治疗及食管胃十二指肠镜检查后确诊。确诊后不久，使用IgE检测（皮肤点刺试验和血清特异性IgE）和特应性皮炎贴片试验（APT）对他们进行过敏测试。根据测试结果开出为期12个月的定制饮食。B组患者继续使用PPI两个月，同时在确诊后的前5个月还为他们开了吞咽局部类固醇药物，在研究的其余时间按需使用。在研究结束时重复进行内镜检查。
牛奶和鸡蛋是最常见的APT阳性过敏原。32名患者被指示遵循排除饮食，A组18名患者中有15名完成，B组14名患者中有12名完成。完成研究的26/27名患者报告症状有所改善。B组在按需使用期间吞咽皮质类固醇的使用明显减少。活检中嗜酸性粒细胞显著减少；一年后，嗜酸性粒细胞从42.84±18.08降至6.41±3.20。
所有患有轻度症状的EoE儿童在进行过敏驱动的排除饮食一年后，症状得到缓解，食管黏膜嗜酸性粒细胞恢复正常。患有中度/重度EoE症状的患者也有同样的改善，表明排除饮食是皮质类固醇的一种有效辅助治疗方法。
