Monzani Alice, Cerutti Marta, Curto Sara, Lovaste Sara, Coppola Marta, Mercalli Francesca, Saettone Silvia, Rabbone Ivana
Division of Pediatric, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
Unit of Pathology, Maggiore Della Carità University Hospital, Novara, Italy.
Front Pediatr. 2024 Mar 19;12:1379162. doi: 10.3389/fped.2024.1379162. eCollection 2024.
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammation of the esophagus, characterized by symptoms related to esophageal dysfunction, resulting from severe eosinophilic infiltration of the esophageal mucosa. It is common in atopic subjects and food antigens have been identified as the most common triggers. However, a seasonal variation in EoE prevalence, correlated with air pollen levels, is reported, suggesting that also aeroallergens may play a role. Little is known about the interplay between EoE and concomitant atopy treatment for aeroallergens.
We describe the case of an 11-year-old boy who presented dysphagia, vomiting, drooling, and chest pain while eating meat, developed 15 months after receiving sublingual immunotherapy (SLIT) for Alternaria (SUBLIVAC®). He underwent esophagogastroduodenoscopy (EGD) revealing severe eosinophilic predominant inflammation (100 eos/HPF), consistent with the diagnosis of EoE, not improving at the EGDs performed after both omeprazole and topical corticosteroids treatment, despite symptom improvement. Afterward, immunotherapy was switched from sublingual to injective form. At the EGD performed 1 month later, macroscopic examination of the esophageal mucosa was normal and eosinophilic infiltration was significantly decreased (5-10 eos/HPF).
SLIT may induce EoE by chronic antigenic exposure of oral mucosa in patients with a robust allergic susceptibility: while attenuating the IgE-mediated immune reactions, the progressive contact with the causative allergen might induce a chronic stimulation of the immune system with the consequent activation of tissue eosinophils. Our data suggest monitoring patients receiving SLIT for EoE symptoms and to discontinue SLIT on their earlier appearance, possibly as a first-line treatment.
嗜酸性粒细胞性食管炎（EoE）是一种慢性免疫介导的食管炎症，其特征为与食管功能障碍相关的症状，由食管黏膜严重嗜酸性粒细胞浸润引起。该病在特应性个体中常见，食物抗原被认为是最常见的触发因素。然而，有报道称EoE患病率存在季节性变化，与空气中花粉水平相关，这表明气传变应原可能也起作用。关于EoE与同时进行的气传变应原特应性治疗之间的相互作用知之甚少。
我们描述了一名11岁男孩的病例，他在接受针对链格孢属的舌下免疫疗法（SLIT，商品名SUBLIVAC®）15个月后，出现了吞咽困难、呕吐、流口水以及进食肉类时胸痛的症状。他接受了食管胃十二指肠镜检查（EGD），显示严重的以嗜酸性粒细胞为主的炎症（100个嗜酸性粒细胞/高倍视野），符合EoE的诊断，尽管症状有所改善，但在使用奥美拉唑和局部皮质类固醇治疗后的EGD检查中并未改善。此后，免疫疗法从舌下给药改为注射给药。1个月后进行的EGD检查显示，食管黏膜的宏观检查正常，嗜酸性粒细胞浸润显著减少（5 - 10个嗜酸性粒细胞/高倍视野）。
SLIT可能通过对具有强烈过敏易感性的患者口腔黏膜进行慢性抗原暴露而诱发EoE：在减轻IgE介导的免疫反应的同时，与致病变应原的逐渐接触可能会导致免疫系统的慢性刺激，从而激活组织嗜酸性粒细胞。我们的数据表明，应对接受SLIT的患者进行EoE症状监测，并在症状早期出现时停用SLIT，这可能作为一线治疗方法。
