Williamson Prerana, Aceves Seema
Department of Pediatrics, University of California San Diego, 9500 Gilman Drive MC 0760, La Jolla, CA, 92093, USA.
Division of Pediatric Gastroenterology, University of California San Diego, 9500 Gilman Drive MC 0760, La Jolla, CA, 92093, USA.
Curr Gastroenterol Rep. 2019 Nov 20;21(11):56. doi: 10.1007/s11894-019-0729-y.
The purpose of this article is to review recent developments demonstrating the role of allergies, the utility of allergy testing, and the role of the allergist in eosinophilic esophagitis (EoE) management.
The majority of patients with EoE have concurrent atopic disorders including food anaphylaxis, asthma, allergic rhinitis, and eczema. An atopic population likely is at greater risk for EoE. Delayed type hypersensitivity to food antigens is the most common pathogenic mechanism. Aeroallergens and pollen-food cross-reactivity also can trigger EoE. Th2 cell-mediated adaptive and innate immunity in response to epithelial damage occurs via IL-13- and IL-4-producing T cells and innate lymphoid cells. While IgE testing for foods is insufficient to build an elimination diet, IgE-mediated allergy may play a role in EoE severity and clinical course. There is strong evidence that Th2 immunity drives EoE. Optimal EoE management should include elucidating and managing EoE triggers and concurrent atopic diatheses.
本文旨在回顾近期的研究进展，这些进展揭示了过敏在嗜酸性食管炎（EoE）中的作用、过敏检测的效用以及过敏症专科医生在EoE管理中的作用。
大多数EoE患者同时患有特应性疾病，包括食物过敏、哮喘、过敏性鼻炎和湿疹。特应性人群患EoE的风险可能更高。对食物抗原的迟发型超敏反应是最常见的致病机制。气传变应原和花粉-食物交叉反应也可引发EoE。Th2细胞介导的适应性免疫和先天性免疫对上皮损伤的反应是通过产生IL-13和IL-4的T细胞以及先天性淋巴细胞发生的。虽然食物的IgE检测不足以制定排除饮食，但IgE介导的过敏可能在EoE的严重程度和临床病程中起作用。有强有力的证据表明Th2免疫驱动EoE。EoE的最佳管理应包括明确和管理EoE的触发因素以及并发的特应性素质。
