Philpott Hamish, Thien Francis
Department of Respiratory and Sleep Medicine Eastern Health, Monash University, 3 Arnold St Box Hill, Melbourne, 3128, Australia.
Curr Treat Options Gastroenterol. 2017 Mar;15(1):26-34. doi: 10.1007/s11938-017-0125-3.
Allergy testing has been advocated for patients with eosinophilic esophagitis (EoE) as a means of defining food triggers and directing dietary therapy. Several recent and comprehensive studies have demonstrated the futility of skin prick (SPT), skin patch (APT) and serum food antigen specific IgE (SIgE) estimates in this context. Furthermore, if identification of food triggers is the endpoint (as opposed to the ability of an allergy test-directed diet merely to induce remission), previous positive studies have limitations. Evolving evidence that EoE may be a non-IgE-mediated disease has led to trials of new assays including serum IgG to food allergens, the cytokine thymic stromal lymphopoietin (TSLP) and basophil activation, all without success. Rather than using allergy test-directed diets, the clinician should use empirical elimination diets which are practical, and consider minimally invasive sampling of the oesophagus to facilitate dietary reintroduction. Research should be redoubled to consider not only assays to predict food triggers but also those that monitor disease activity. The anti-inflammatory effect of proton pump inhibitors and deficits in barrier integrity may influence the success of dietary therapy and the results of allergy tests and should be considered in future research design.
对于嗜酸性粒细胞性食管炎（EoE）患者，一直有人主张进行过敏测试，以此作为确定食物诱因并指导饮食治疗的一种方法。最近的几项全面研究表明，在这种情况下，皮肤点刺试验（SPT）、皮肤斑贴试验（APT）和血清食物抗原特异性IgE（SIgE）检测毫无用处。此外，如果确定食物诱因是终点（与仅通过过敏测试指导饮食来诱导缓解的能力相反），那么之前的阳性研究也存在局限性。越来越多的证据表明EoE可能是一种非IgE介导的疾病，这导致了对新检测方法的试验，包括针对食物过敏原的血清IgG、细胞因子胸腺基质淋巴细胞生成素（TSLP）和嗜碱性粒细胞活化试验，但均未成功。临床医生不应采用过敏测试指导的饮食，而应采用实用的经验性排除饮食，并考虑对食管进行微创采样，以方便重新引入饮食。应加倍努力进行研究，不仅要考虑预测食物诱因的检测方法，还要考虑监测疾病活动的方法。质子泵抑制剂的抗炎作用和屏障完整性的缺陷可能会影响饮食治疗的效果和过敏测试的结果，在未来的研究设计中应予以考虑。
