Molecular Sensitization Pattern Profile in Proton Pump Inhibitor-Responsive Esophageal Eosinophilia Vs Proton Pump Inhibitor-Nonresponsive Eosinophilic Esophagitis (EoE) in Adult Patients

Rationale: Recent studies showed that proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) may be an EoE variant. Component resolved diagnosis (CRD) allows to distinguish primary sensitization from sensitization due to cross-reactivity. The aim of this study was to describe the allergen sensitization profile in PPI-REE and PPI non responsive EoE (PPI-nREE) by means of CRD.

Methods: Eighty two patients with confirmed EoE and CRD diagnosis were included. Specific IgE antibodies against 103 and 112 different allergen components were measured by ImmunoCAP MIA-ISAC (Thermofischer Diagnostics, Uppsala, Sweden) in 36 and 46 patients, respectively. 

Results: Most patients were male (78%) and the mean age was 34.9 ± 12.3 years. Twenty-six patients had PPI-REE, 35 PPI-nREE and response to PPI was not confirmed in 23. No significant differences were found between groups regarding sex (p=0.142) and age (p=0.876).  Peripheral eosinophilia was statistically significantly higher in PPI-nREE than in PPI-REE (median: 420 vs 235 cel/mm³; p=0.025)(range: 40-970 vs 50-710 cel/mm³), whereas there were no significant differences regarding serum total IgE, eosinophilic cationic protein or tryptase. Besides, no significant differences in allergen sensitization were found between PPI-REE and PPI-nREE, except regarding to Can f 5 sensitization (p=0.018), which showed higher IgE levels in the PPI-REE group. 

Conclusions: We found no statistically significant differences regarding to serum total IgE, tryptase, eosinophilic cationic protein and allergen sensitization between PPI-REE and PPI-nREE, except the higher levels of Can f 5 in the PPI-REE group. Peripheral eosinophilia was higher in PPI-nREE.