Armentia A, Martín-Armentia S, Martín-Armentia B, Santos-Fernández J, Álvarez R, Madrigal B, Fernández-González D, Gayoso S, Gayoso M J
Allergy Service, Hospital Universitario Río Hortega, Valladolid University, Spain.
Pediatric Service, Hospital Rio Carrión, Palencia, Spain.
Allergol Immunopathol (Madr). 2018 Mar-Apr;46(2):181-189. doi: 10.1016/j.aller.2017.11.001. Epub 2018 Jan 12.
Eosinophilic esophagitis (EoE) is characterized by esophageal dysfunction and, histologically, by eosinophilic inflammation. There is not a clear etiologic treatment. Biopsies analysis using plant histology methods may show callose and pollen tubes in the esophageal mucosa. Component-resolved diagnosis (CRD) with microarrays could detect possible allergens involved and indicate an elimination diet and allergen immunotherapy (AIT).
One hundred and twenty-nine patients with EoE were tested for environmental and food allergens. CRD, histological and botanical analysis were performed. Clinical scores and endoscopic biopsy were performed every six months for three years. Fifty healthy patients, 50 asthmatics due to pollen, and 53 celiac disease patients were included as comparison groups. CRD-directed AIT was administered in 91 EoE patients and elimination diet in 140 patients (87 EoE and all 53 CD patients).
CRD detected allergen hypersensitivity in 87.6% of patients with EoE. The predominant allergens were grass group 1 (55%), lipid transfer proteins (LTP) of peach and mugwort, hazelnuts and walnuts. Callose from pollen tubes was found in 65.6% of biopsies. After CRD-guided elimination diet and/or AIT, 101 (78.3%) EoE patients showed significant clinical improvement (p<0.017) and 97 (75.2%) were discharged (negative biopsy, no symptoms, no medication) without relapse. AIT-treated patients had better outcomes (odds ratio 177.3, 95% CI 16.2-1939.0).
CRD-directed AIT and/or elimination diet was efficient in treating EoE patients and was well tolerated.
嗜酸性粒细胞性食管炎（EoE）的特征是食管功能障碍，组织学上表现为嗜酸性粒细胞炎症。目前尚无明确的病因治疗方法。使用植物组织学方法进行活检分析可能会在食管黏膜中显示胼胝质和花粉管。利用微阵列进行的组分分辨诊断（CRD）可以检测出可能涉及的过敏原，并指导实施排除饮食和过敏原免疫疗法（AIT）。
对129例EoE患者进行环境和食物过敏原检测。进行了CRD、组织学和植物学分析。在三年时间里，每六个月进行一次临床评分和内镜活检。纳入50名健康患者、50名花粉诱发哮喘患者和53名乳糜泻患者作为对照组。91例EoE患者接受了CRD指导的AIT，140例患者（87例EoE患者和所有53例CD患者）接受了排除饮食。
CRD在87.6%的EoE患者中检测到过敏原超敏反应。主要过敏原是1组禾本科花粉（55%）、桃和艾蒿的脂质转移蛋白（LTP）、榛子和核桃。65.6%的活检样本中发现了来自花粉管的胼胝质。在CRD指导的排除饮食和/或AIT后，101例（78.3%）EoE患者临床症状显著改善（p<0.017），97例（75.2%）患者病情缓解（活检阴性、无症状、无需用药）且无复发。接受AIT治疗的患者预后更好（优势比177.3，95%可信区间16.2 - 1939.0）。
CRD指导的AIT和/或排除饮食对EoE患者治疗有效且耐受性良好。
