Department of Pediatric Allergy, Gazi University Faculty of Medicine, Ankara, Turkey.
Gazi University Pediatric Eosinophilic Gastrointestinal Diseases Working Group, Ankara, Turkey.
Allergy. 2023 Dec;78(12):3235-3240. doi: 10.1111/all.15881. Epub 2023 Sep 13.
Food-induced immediate response of the esophagus (FIRE) is a new phenomenon that has been described in eosinophilic esophagitis (EoE) patients. It is suspected when unpleasant symptoms occur suddenly on contact of the triggering food with the esophageal surface and recur with repeated exposures. It can often be mistaken for pollen-food allergy syndrome (PFAS) and solid food dysphagia. Data on FIRE is limited to one survey study and case reports, and there are no screening studies conducted on either adults or children with EoE. In this study, we aimed to screen children aged ≥7 years old with EoE for FIRE.
Demographic data were collected from medical records. A questionnaire about FIRE was applied to all participants. Skin prick tests were done on suspected patients to identify the triggering foods. FIRE is defined as suitable clinical symptoms with suspected food allergen exposure.
A total of 78 patients (74.4% male, median age: 13.5 years) were included. Unpleasant and recurrent symptoms distinct from dysphagia with specific foods were reported in 16.7% of the patients, all of whom had concomitant allergic rhinitis (AR). The symptoms described by almost all patients were oropharyngeal itching and tingling (PFAS: 15.3%) excluding only one patient reporting retrosternal narrowing and pressure after specific food consumption (FIRE: 1.2%).
Although definitive conclusions regarding the true prevalence of FIRE cannot be made, it does not seem to be common as PFAS. However, it deserves questioning particularly in the presence of concurrent AR and/or PFAS in children with EoE.
食物诱导的食管即刻反应（FIRE）是一种新现象，已在嗜酸性食管炎（EoE）患者中描述。当触发食物与食管表面接触时突然出现不愉快症状，并且在反复暴露时反复出现时，怀疑会出现这种情况。它通常可能被误认为花粉-食物过敏综合征（PFAS）和固体食物吞咽困难。关于 FIRE 的数据仅限于一项调查研究和病例报告，并且尚未对患有 EoE 的成人或儿童进行任何筛查研究。在这项研究中，我们旨在筛查患有 EoE 的≥7 岁儿童的 FIRE。
从病历中收集人口统计学数据。向所有参与者应用有关 FIRE 的问卷。对疑似患者进行皮肤点刺试验以确定触发食物。FIRE 被定义为具有可疑食物过敏原暴露的合适临床症状。
共纳入 78 例患者（74.4%为男性，中位年龄：13.5 岁）。16.7%的患者报告有不同于吞咽困难的不适和反复发作的症状，所有患者均伴有过敏性鼻炎（AR）。几乎所有患者描述的症状是口咽瘙痒和刺痛（PFAS：15.3%），只有一名患者报告在食用特定食物后胸骨后狭窄和压迫感（FIRE：1.2%）除外。
尽管无法对 FIRE 的真实患病率得出明确结论，但它似乎并不像 PFAS 那样常见。然而，在患有 EoE 的儿童中，如果同时存在 AR 和/或 PFAS，则尤其值得质疑。
