Suto Daisuke, Murata Kazumoto, Otake Takaaki, Ichiishi Eiichiro, Sato Kiichi, Okada Shinya, Okano Mitsuhiro, Kohgo Yutaka
Department of Gastroenterology, International University of Health and Welfare Hospital, Nasushiobara, Japan.
Division of Virology, Department of Infection and Immunity, Jichi Medical University, Shimotsuke, Japan.
Asia Pac Allergy. 2021 Oct 26;11(4):e44. doi: 10.5415/apallergy.2021.11.e44. eCollection 2021 Oct.
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease associated with eosinophilic infiltration of the esophageal mucosa mostly due to exposure to allergens. However, the causes and pathogenesis of EoE are not fully understood. We encountered a case of EoE that was triggered by sublingual immunotherapy (SLIT) for cedar pollen allergy. A 40-year-old man who was treated with Japanese cedar pollen tablet SLIT for cedar pollen allergy developed heartburn 3 weeks after the initiation of the treatment. He took vonoprazan for the heartburn, but the heartburn did not improve. Then, esophagogastroduodenoscopy was performed; it revealed longitudinal furrows and white spots on the esophageal mucosa, decreased vascular permeability, and erosions. Consequently, the patient was diagnosed with EoE. Heartburn and chest discomfort disappeared 1 week after the discontinuation of Japanese cedar pollen tablet SLIT, and the patient tested positive for drug allergy to Japanese cedar pollen tablet SLIT. In this study, we found that if heartburn persists during SLIT for cedar pollen allergy, and does not improve on administration of vonoprazan or proton pump inhibitors, EoE should be suspected. In addition, the occurrence of EoE due to drug allergy is indicated.
嗜酸性粒细胞性食管炎（EoE）是一种慢性炎症性疾病，主要由于接触过敏原导致食管黏膜嗜酸性粒细胞浸润。然而，EoE的病因和发病机制尚未完全明确。我们遇到一例因雪松花粉过敏进行舌下免疫治疗（SLIT）引发的EoE病例。一名40岁男性因雪松花粉过敏接受日本雪松花粉片SLIT治疗，治疗开始3周后出现烧心症状。他服用沃克治疗烧心，但症状未改善。随后进行了食管胃十二指肠镜检查；结果显示食管黏膜有纵向皱襞和白斑，血管通透性降低以及糜烂。因此，该患者被诊断为EoE。停用日本雪松花粉片SLIT 1周后，烧心和胸部不适消失，且该患者对日本雪松花粉片SLIT药物过敏检测呈阳性。在本研究中，我们发现，如果在雪松花粉过敏的SLIT治疗期间烧心持续存在，且服用沃克或质子泵抑制剂后无改善，则应怀疑EoE。此外，提示存在因药物过敏导致的EoE。
