Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital of Colorado, 13123 East 16th Ave, Box 518, Aurora, CO, 80045, USA.
Gastrointestinal Eosinophilic Disease Program, University of Colorado School of Medicine, 13123 East 16th Ave, B290, Aurora, CO, 80045, USA.
Curr Allergy Asthma Rep. 2018 Jun 16;18(8):43. doi: 10.1007/s11882-018-0798-2.
Observations suggesting that aeroallergens trigger eosinophilic esophagitis (EoE) in a subset of patients raise questions about the implications this finding has on the evaluation and management of patients with EoE, including a potential role for allergen immunotherapy.
The majority of studies evaluating the potential role of aeroallergens as provocateurs of EoE have addressed this issue by assessing the seasonal variation in EoE diagnosis and/or symptom onset or worsening, with mixed results. For various reasons, reaching accurate conclusions based on this methodology is potentially fraught with error. In addition, studies examining the even harder to assess role of perennial aeroallergens in triggering EoE are lacking. Although clearly not the majority, there may be a subset of patients with EoE and allergic rhinitis in whom exposure to aeroallergens to which they are sensitized contributes to esophageal eosinophilia either through direct chronic esophageal mucosal contact with pollen allergens or from repetitive exposure of the esophageal mucosa to pollen allergens, mediators, and eosinophils in swallowed nasal secretions. Therefore, evaluation for and optimal treatment of comorbid allergic rhinitis in EoE patients are clearly indicated. Recognition of the potential role of aeroallergens as triggers of EoE also raises the question of whether allergen immunotherapy might be an effective form of EoE treatment. Reports of sublingual immunotherapy (SLIT) inducing EoE support the notion that aeroallergens can trigger EoE, but negate this approach as a potential form of EoE therapy. In fact, the use of SLIT is contraindicated in patients with EoE. The literature regarding the role of subcutaneous immunotherapy (SCIT) in patients with EoE is limited. Current evidence indicates that it should not be typically recommended; however, SCIT might benefit a subset of patients with EoE and uncontrolled allergic rhinitis on conventional therapies in whom SCIT would otherwise be indicated for allergic rhinoconjunctivitis, particularly in those with sensitizations to pollens containing allergens that cross react with food allergens. The purpose of this review is to discuss the current literature examining the role of aeroallergens in triggering EoE with a focus on the potential clinical implications of this finding on managing patients with EoE.
有观察表明，气传变应原在一部分嗜酸粒细胞性食管炎（EoE）患者中引发该病，这对 EoE 的评估和管理提出了一些问题，包括变应原免疫治疗的潜在作用。
多数研究通过评估 EoE 诊断和/或症状发作或恶化的季节性变化来评估气传变应原作为 EoE 促发因素的潜在作用，结果不一。由于各种原因，基于这种方法得出准确的结论可能存在错误。此外，研究评估更难确定的常年气传变应原在引发 EoE 中的作用的研究也很缺乏。虽然可能不是大多数，但可能有一部分 EoE 患者和变应性鼻炎患者，他们暴露于致敏的气传变应原可能通过花粉变应原与食管黏膜的直接慢性接触，或通过吞咽鼻分泌物中花粉变应原、介质和嗜酸性粒细胞对食管黏膜的反复暴露，导致食管嗜酸性粒细胞增多。因此，对 EoE 患者进行共患变应性鼻炎的评估和最佳治疗显然是必要的。认识到气传变应原作为 EoE 触发因素的潜在作用也提出了变应原免疫治疗是否可能是 EoE 治疗的有效形式的问题。舌下免疫治疗（SLIT）诱导 EoE 的报告支持气传变应原可引发 EoE 的观点，但否定了这种方法作为 EoE 治疗的一种潜在形式。事实上，SLIT 在 EoE 患者中是禁忌的。关于皮下免疫治疗（SCIT）在 EoE 患者中的作用的文献有限。目前的证据表明，通常不建议使用它；然而，SCIT 可能对接受常规治疗的 EoE 和未经控制的变应性鼻炎患者中的一部分有益，在这些患者中，SCIT 对变应性鼻结膜炎是有指征的，特别是对那些对含有与食物变应原发生交叉反应的变应原的花粉致敏的患者。本综述的目的是讨论目前评估气传变应原在引发 EoE 中的作用的文献，重点是这一发现对管理 EoE 患者的潜在临床意义。
