Could Allergen Immunotherapy be a Therapeutic Intervention in Eosinophilic Oesophagitis?
Saturday, March 5, 2016: 3:00 PM
Room 408B (Convention Center)
Moises A. Calderon, MD PhD
Rationale: Eosinophilic esophagitis (EoE) is characterized by esophageal dysfunction and, histologically, by eosinophilic inflammation. Although different therapeutic interventions are used to improve EoE, there is no aetiological treatment and diet exclusion is difficult. Objective: Component resolved diagnostic (CRD) may be useful in detecting the allergens that might be involved in this inflammatory process. This will allow the selection of a proper diet and allergen immunotherapy (AIT) to treat EoE.

Methods: 55 patients with clinical and histological diagnosis of EoE were tested for environmental and food allergens. CRD analysis with microarray technology was performed.  Clinical evolution, including adjusted symptom scores and endoscopic biopsy, were performed every six months for 2 years. 50 healthy patients served as control group. Subcutaneous AIT (SCIT- ALK Abelló) was administered in 39 patients with EoE. Exclusion diet was indicated according to CRD (only 1 or 2 group of food avoidance).

Results: Allergy was detected in 88% of patients with EoE. The predominant allergens were grasses group 1 and, in particular, nCyn d 1 (Cynodon dactylon) or Bermuda grass pollen, followed by lipid transfer proteins (LTP) of peach and mugwort, hazelnuts and walnuts. After two years of the array-guided exclusion diet and SCIT, patients with EoE showed a significant clinical improvement and 68% of patients were discharged from clinic (cure based on negative biopsy, no symptoms, no medication intake).

Conclusions: In patients with EoE, sensitization to plant foods and pollen is important. AIT seems to be efficacious and well tolerated in patients with EoE.