Eosinophilic Esophagitis Like Oral Immunotherapy Related Syndrome (ELORS)
Monday, March 5, 2018
South Hall A2 (Convention Center)
Richard L. Wasserman, MD PhD FAAAAI, Robert W. Sugerman, MD FAAAAI, Qurat Ul Ain Kamili, MD, Dena M. Pence, RRT, Angela R. Hague, PA-C, Morley Herbert, PhD
RATIONALE: Food oral immunotherapy (FOIT) has gained increasing popularity over the past ten years. Eosinophilic esophagitis is a known complication of FOIT. We report a characteristic presentation of vomiting with or without epigastric abdominal pain or nausea occurring 2-8 hours after FOIT doses often accompanied by increased peripheral blood eosinophilia, described as ELORS.

METHODS: North Texas IRB approved retrospective record review of patients receiving FOIT. FOIT was administered according to previously reported protocols.

RESULTS: ELORS developed during escalation in 10% (51/498) of all FOIT patients, with a rate per food of 13% (13/103) milk, 13% (34/271) peanut, 4% (1/24) single tree nut, 8% (3/36) peanut plus multiple tree nut. No wheat (0/7) or egg (0/56) FOIT patients developed ELORS during escalation. 28 ELORS patients reduced the escalation dose until they were asymptomatic and continued the reduced dose for >8 weeks before resuming the escalation protocol. 57% (16/28) reached maintenance, 18% (5/28) discontinued treatment because of continued ELORS symptoms, and 21% (6/28) for other reasons. 37% (19/51) of ELORS patients discontinued treatment because of ELORS without attempting dose reduction. Two ELORS patients discontinued treatment then restarted peanut OIT later and successfully reached maintenance.

CONCLUSIONS: ELORS comprises a recognizable syndrome affecting some FOIT patients. In many patients, ELORS resolves after 2-3 months of FOIT dose reduction and successful desensitization can ultimately be achieved. ELORS substantially limits FOIT for some patients.