Study and Follow-Up of Patients with Allergic Eosinophilic Esophagitis Phenotype

Background: Eosinophilic esophagitis (EoE) is a complex entity characterized by the variety of phenotypes and multiple management possibilities options with regard to diets and drugs. Recent publications discourage the prick test use or the specific IgE determination to detect food allergens in these patients. Our aim is to assess the EoE patients allergic sensitization profile and objectify the utility of ECP (eosinophilic cationic protein) or eosinophils in peripheral blood as an inflammation biomarkers for the follow-up of patients with EoE treated with specific diets, based on the hypothesis that we will observe a biomarkers decrease and clinical improvement after maintenance of these allergy test based diets.

Methods: 37 patients diagnosed with EoE (25 males and 12 females) between January 2012 and June 2018, aged between 16 and 74 (38,83±14,55 years), were included consecutively. In all cases, we proceeded to perform prick test with extensive allergen batteries and specific IgE determination. Patients were assessed with results to recommend diets based on the tests performed and for serial biomarker determination.

Results: 25 patients performed strictly the protocol of analytical extraction and the maintenance of the indicated diets, 24 of whom showed optimum response to specific diets based on allergy testing. A statistically significant difference ECP decrease and increase were observed in our patients with the food triggers withdrawal and reintroduction.

Conclusion: In our experience, there is an allergic phenotype of patients with EoE who can benefit from classic allergy tests, specific diets indication and biomarkers follow-up especially ECP. We believe that this profile of patients is similar in terms of evolution and response to patients with allergic asthma.

Keywords: Eosinophilic esophagitis, Eosinophil cationic protein, Specific diet, Food allergy.