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Vol. 46. Issue 2.
Pages 181-189 (March - April 2018)
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Vol. 46. Issue 2.
Pages 181-189 (March - April 2018)
Original Article
DOI: 10.1016/j.aller.2017.11.001
Is eosinophilic esophagitis an equivalent of pollen allergic asthma? Analysis of biopsies and therapy guided by component resolved diagnosis
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A. Armentiaa,
Corresponding author
aliciaarmentia@gmail.com

Corresponding author.
, S. Martín-Armentiab, B. Martín-Armentiaa,1, J. Santos-Fernándezc, R. Álvarezd, B. Madrigale, D. Fernández-Gonzálezf,g, S. Gayosoh, M.J. Gayosoh
a Allergy Service, Hospital Universitario Río Hortega, Valladolid University, Spain
b Pediatric Service, Hospital Rio Carrión, Palencia, Spain
c Gastroenterology Service, Hospital Clínico Universitario, Valladolid, Spain
d Molecular Biology Department, Cellular Biology Area, León University, León, Spain
e Histopathology Department, Hospital Universitario Río Hortega, Valladolid, Spain
f Biodiversity and Environmental Management, University of León, León, Spain
g Institute of Atmospheric Sciences and Climate, National Research Council, Bologna, Italy
h Histology Department, Valladolid University, Spain
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Tables (2)
Table 1. Specific allergens detected by CRD, SPT and IgE in > 10% of patients tested.
Table 2. Clinical outcomes of EoE patients after AIT and/or elimination diet.
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Abstract
Background

Eosinophilic esophagitis (EoE) is characterized by esophageal dysfunction and, histologically, by eosinophilic inflammation. There is not a clear etiologic treatment. Biopsies analysis using plant histology methods may show callose and pollen tubes in the esophageal mucosa. Component-resolved diagnosis (CRD) with microarrays could detect possible allergens involved and indicate an elimination diet and allergen immunotherapy (AIT).

Methods

One hundred and twenty-nine patients with EoE were tested for environmental and food allergens. CRD, histological and botanical analysis were performed. Clinical scores and endoscopic biopsy were performed every six months for three years. Fifty healthy patients, 50 asthmatics due to pollen, and 53 celiac disease patients were included as comparison groups. CRD-directed AIT was administered in 91 EoE patients and elimination diet in 140 patients (87 EoE and all 53 CD patients).

Results

CRD detected allergen hypersensitivity in 87.6% of patients with EoE. The predominant allergens were grass group 1 (55%), lipid transfer proteins (LTP) of peach and mugwort, hazelnuts and walnuts. Callose from pollen tubes was found in 65.6% of biopsies. After CRD-guided elimination diet and/or AIT, 101 (78.3%) EoE patients showed significant clinical improvement (p<0.017) and 97 (75.2%) were discharged (negative biopsy, no symptoms, no medication) without relapse.

AIT-treated patients had better outcomes (odds ratio 177.3, 95% CI 16.2–1939.0).

Conclusion

CRD-directed AIT and/or elimination diet was efficient in treating EoE patients and was well tolerated.

Keywords:
Eosinophilic esophagitis
Allergen immunotherapy
Component-resolved diagnosis
Pollen tube
Biopsy
Abbreviations:
IgE
CAP
SACYL
CRD

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