Specific immunotherapy can be a useful treatment in seasonal pollen
induced esophagitis
Abstract
Background Although pollen allergy is a very frequent finding
in patients with eosinophilic esophagitis (EoE), it was doubted that it
was an etiological agent to consider. Many EoE patients present
rhinoconjunctivitis, atopic dermatitis and associated asthma, in
addition to dysphagia and food impaction. EoE exacerbations are often
seasonal. Methods We performed a real life study. Allergens
involved in EoE were identified by prick, specific IgE and component
resolved diagnosis (CRD) by microarrays. We selected 255 patients
suffered from esophagitis with seasonal exacerbation, and performed a
trial with specific immunotherapy with the detected pollen and avoidance
of food, if was also detected. Microscopic examination of esophageal
biopsies of patients with EoE were made to verify the presence of
callose (polysaccharide abundant in the polinic tubes during
germination, but absent in animal tissues) in the esophagus. Callose was
detected using histological sections stained with sirofluor
fluorochrome. Endoscopy and biopsy were performed ever six months of
treatment. Esophageal mucosal sections were analyzed by scanning
electron microscope Results Diagnosis of allergen
hypersensitivity using molecular microarray analysis CRD and biopsy
study was more efficient in esophagitis than other tests and was useful
to decide the treatment (avoidance or targeted immunotherapy) and
allowed us a more reasonable restriction of food in the diet and
specific immunotherapy aimed at the suspected allergens responsible for
the disease. After immunotherapy, 188 (74%) patients were discharged
whit negative biopsy, no symptoms, no medication, without relapse
Conclusion Specific immunotherapy achieved clinic resolution
and objective improvement by normal biopsy.