2078 The use of aeroallergen immunotherapy to treat eosinophilic esophagitis

Thursday, 15 October 2015
Hall D1 Foyer (Floor 3) (Coex Convention Center)

Muhammad Imran, MD , Allergy & Clinical Immunology, Kansas University Medical Center, Kansas City, KS

Introduction: Eosinophilic esophagitis (EoE) is characterized by symptoms of esophageal dysfunction, eosinophilia of the esophagus, and may be associated with other atopic disorders. The pathogenesis of EoE is likely a mixed IgE and non-IgE food-mediated reaction with Th2 cytokines driving esophageal eosinophilia. Hence, therapy is aimed at inflammation control, with corticosteroids (oral or topical) and/or food antigen avoidance. However, these treatments are not specific, impair quality of life, and have significant side effects. Therefore, there is an ongoing effort to design alternative therapies.

Background: To determine if EoE patients with concomitant seasonal or perennial allergic rhinitis improve with aeroallergen immunotherapy (IT).

Methods:  We present a case series of 3 Caucasian patients with a history of atopy and EoE based on characteristic clinical symptoms, EGD findings, and esophageal biopsy. One had oral allergy syndrome.  None of the patients had peripheral eosinophilia. Two had seasonal exacerbations of their EoE symptoms.  These patients were all started on aeroallergen immunotherapy for atopic disease other than EoE.

Results: In this small group of aeroallergen and food sensitized adult patients, we demonstrated a lack of improvement in clinical symptoms of EoE with aeroallergen immunotherapy while making no modifications in diet or oral medications. It is difficult to ascertain improvement due to the lack of a validated adult symptom score and inherent restraints of repeat esophageal endoscopy due to cost and procedural risks.  It is also unclear if the biopsy always accurately reflects disease activity. There are several limitation of this small sample which includes absence of a control group, no statistical validity, and possible selection bias.

Conclusions: We would like to continue further evaluation of the prevalence of aeroallergen sensitized adults with EoE and will consider a similar evaluation of pediatric patients. We will review further data at an attempt to isolate a population in which improvement with aeroallergen immunotherapy may be successful in improving control of EoE without aggressive dietary modifications or medication management.