Allergen Immunotherapy in Patients with Eosinophilic Esophagitis
Sunday, March 4, 2018
South Hall A2 (Convention Center)
Scott P. Commins, MD PhD, Benjamin Robey, Barrett Barnes, Craig C Reed, Swathi Eluri, Michelle L. Hernandez, MD FAAAAI, Maya R. Jerath, MD PhD FAAAAI, Evan S. Dellon, MD MPH
RATIONALE: Many patients with eosinophilic esophagitis (EoE) have concomitant atopic disorders such as allergic rhinitis, asthma, and atopic dermatitis which can be treated with subcutaneous allergen immunotherapy (IT). However, there are limited data describing the role of IT in the treatment of EoE.

METHODS: We conducted a retrospective cohort study using a central data repository search of patients with EoE and patients treated with IT between 2008-2016. Patients were included if they met EoE consensus guidelines and were treated with IT. Patients with EoE not treated with IT (-IT) were compared to those who received IT (EoE+IT).

RESULTS: Of 677 confirmed EoE cases, 14 had concomitant IT. Age, sex, and race were similar. EoE+IT patients had more rhinitis/sinusitis (100% vs 40%; p=0.01) and asthma (60% vs 24%; p=0.01). Rates of food allergy were not different. EoE+IT patients had longer duration of symptoms prior to diagnosis (13.8±8.8yrs vs 7.3±8.6), but endoscopic findings were similar. At follow-up, 57% had a histological response (<15 eos/hpf) and 50% had a symptom response. These same patients had a 20% histological response and 40% symptom response to initial treatment. Compared to initial EGD, at follow up there was less use of topical steroids (80% vs 28%) and more dietary elimination (10% vs 78%).

CONCLUSIONS: At follow-up, response rates in the EoE+IT group were improved even with less topical steroid use. In this cohort, IT did not adversely impact outcomes, and further research is warranted to elucidate the role for IT in the treatment of EoE.