Letner D, Farris A, Khalili H, Garber J
Gastrointestinal Unit, Massachusetts General Hospital.
Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Dis Esophagus. 2018 Feb 1;31(2). doi: 10.1093/dote/dox122.
Eosinophilic esophagitis (EoE) is associated with atopic diseases including asthma, allergic rhinitis, and atopic dermatitis; however, limited data exist on the correlation between pollen-food allergy syndrome (PFAS) and EoE. We analyzed 346 adults with EoE treated at a single center between 2002 and 2016. Demographic and EoE-specific data including clinical features and measures of EoE disease severity and treatments were collected. The presence of other atopic diseases, family history, prevalence of peripheral eosinophilia and elevated IgE, and details of PFAS triggers were collected. Twenty six percent of the 346 subjects in our cohort had both EoE and PFAS (EoE-PFAS). Compared to subjects with EoE alone, subjects with EoE-PFAS had an increased frequency of allergic rhinitis (86.7% vs. 64.2%, P < 0.001) and family history of allergies (71.1% vs. 53.3%, P = 0.003), and comprised a higher proportion of EoE diagnoses made in the spring (Χ2 < 0.001). 43.3% of subjects with concurrent EoE and PFAS opted for treatment with elimination diet, and these measures failed to induce remission in 46.2% of cases. In most cases, elimination diet failed despite strict avoidance of PFAS trigger foods in addition to common EoE triggers including dairy, wheat, and eggs. EoE-PFAS was also associated with higher serum IgE at the time of EoE diagnosis (460.6 vs. 289.9, P < 0.019). Allergic rhinitis and a family history of food allergy were independently associated with having EoE-PFAS. The most common triggers of PFAS in adults with EoE are apples (21.1%), carrots (15.5%), and peaches (15.5%). Along with asthma, allergic rhinitis and atopic dermatitis, PFAS is a common allergic comorbidity that is highly associated with EoE. Further studies aimed at understanding mechanistic similarities and differences of PFAS and EoE may shed light on the pathogenesis of these closely related food allergy syndromes.
嗜酸性粒细胞性食管炎（EoE）与包括哮喘、过敏性鼻炎和特应性皮炎在内的特应性疾病相关；然而，关于花粉 - 食物过敏综合征（PFAS）与EoE之间相关性的数据有限。我们分析了2002年至2016年间在单一中心接受治疗的346例成年EoE患者。收集了人口统计学和EoE特异性数据，包括临床特征、EoE疾病严重程度的测量指标及治疗情况。收集了其他特应性疾病的存在情况、家族史、外周血嗜酸性粒细胞增多和IgE升高的患病率以及PFAS触发因素的详细信息。在我们队列中的346名受试者中，26%同时患有EoE和PFAS（EoE - PFAS）。与单纯患有EoE的受试者相比，患有EoE - PFAS的受试者过敏性鼻炎的发生率更高（86.7%对64.2%，P < 0.001），且有过敏家族史的比例更高（71.1%对53.3%，P = 0.003），并且在春季做出的EoE诊断中占比更高（Χ2 < 0.001）。43.3%同时患有EoE和PFAS的受试者选择采用排除饮食进行治疗，且这些措施在46.2%的病例中未能诱导缓解。在大多数情况下，尽管除了常见的EoE触发食物（包括乳制品、小麦和鸡蛋）之外，严格避免了PFAS触发食物，但排除饮食仍告失败。EoE - PFAS在EoE诊断时还与更高的血清IgE相关（460.6对289.9，P < 0.019）。过敏性鼻炎和食物过敏家族史与患有EoE - PFAS独立相关。EoE成年患者中PFAS最常见的触发因素是苹果（21.1%）、胡萝卜（15.5%）和桃子（15.5%）。与哮喘、过敏性鼻炎和特应性皮炎一样，PFAS是一种常见的过敏性合并症，与EoE高度相关。旨在了解PFAS和EoE机制异同的进一步研究可能会阐明这些密切相关的食物过敏综合征的发病机制。
