O032 The prevalence of eosinophilic esophagitis in patients with IgE-mediated food allergy: Implications for oral immunotherapy

Food allergies, defined as an immune response to food proteins, affect as many as 8% of young children and 2% of adults in western countries, and their prevalence appears to be rising like all allergic diseases. In addition to well-recognized urticaria and anaphylaxis triggered by IgE antibody– mediated immune responses, there is an increasing recognition of cell-mediated disorders, such as eosinophilic esophagitis and food protein–induced enterocolitis. Non-IgE-Mediated gastrointestinal food allergies are a heterogeneous group of food allergies in which there is an immune reaction against food but the primary pathogenesis is not a production of IgE and activation of mast cells and basophils. Those diseases tend to affect mainly the gastrointestinal tract and can present as acute (FPIES) or chronic reaction, such as Eosinophilic Esophagitis (EoE), Food Protein-Induced Allergic Proctocolitis (FPIAP). The role of food allergy in Non-EoE gastrointestinal Eosinophilic disorders (Non- EoE EGID) is poorly understood. In some diseases like EoE, T cell seems to play a major role in initiating the immunological reaction against food, however, in FPIES and FPIAP, the mechanism of sensitization is not clear. Diagnosis requires food challenges and/or endoscopies in most of the patients, as there are no validated biomarkers that can be used for monitoring or diagnosis of Non-IgE mediated food allergies. The treatment of Non-IgE food allergy is dependent on diet (FPIES, and EoE) and/or use of drugs (i.e. steroids, PPI) in EoE and Non-EoE EGID. Non-IgE mediated food allergies are being being investigated.

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Relation between eosinophilic esophagitis and oral immunotherapy for food allergy: a systematic review with meta-analysis

Annals of Allergy Asthma & Immunology ◽

10.1016/j.anai.2014.08.004 ◽

2014 ◽

Vol 113 (6) ◽

pp. 624-629 ◽

Cited By ~ 187

Author(s):

Alfredo J. Lucendo ◽

Ángel Arias ◽

José M. Tenias

Keyword(s):

Systematic Review ◽

Food Allergy ◽

Eosinophilic Esophagitis ◽

Meta Analysis ◽

Oral Immunotherapy

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Using oral food challenges to provide clarity and confidence when diagnosing food allergies

Journal of Food Allergy ◽

10.2500/jfa.2021.3.210002 ◽

2021 ◽

Vol 3 (1) ◽

pp. 3-7 ◽

Cited By ~ 1

Author(s):

Justin Greiwe

Keyword(s):

Food Allergy ◽

Immunoglobulin E ◽

Food Challenge ◽

Clinical History ◽

The United States ◽

Oral Immunotherapy ◽

Food Allergies ◽

Ige Mediated ◽

Challenge Education ◽

Food Challenges

A verified food allergy can be an impactful life event that leads to increased anxiety and measurable effects on quality of life. Allergists play a key role in framing this discussion and can help alleviate underlying fears by promoting confidence and clarifying safety concerns. Correctly diagnosing a patient with an immunoglobulin E (IgE) mediated food allergy remains a nuanced process fraught with the potential for error and confusion. This is especially true in situations in which the clinical history is not classic, and allergists rely too heavily on food allergy testing to provide a confirmatory diagnosis. A comprehensive medical history is critical in the diagnosis of food allergy and should be used to determine subsequent testing and interpretation of the results. Oral food challenge (OFC) is a critical procedure to identify patients with an IgE-mediated food allergy when the history and testing are not specific enough to confirm the diagnosis and can be a powerful teaching tool regardless of outcome. Although the safety and feasibility of performing OFC in a busy allergy office have always been a concern, in the hands of an experienced and trained provider, OFC is a safe and reliable procedure for patients of any age. With food allergy rates increasing and analysis of recent data that suggests that allergists across the United States are not providing this resource consistently to their patients, more emphasis needs to be placed on food challenge education and hands-on experience. The demand for OFCs will only continue to increase, especially with the growing popularity of oral immunotherapy programs; therefore, it is essential that allergists become familiar with the merits and limitations of current testing modalities and open their doors to using OFCs in the office.

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Alergia Alimentaria, puntos clave para la práctica clínica

Revista Alergia México ◽

10.29262/ram.v67i3.741 ◽

2021 ◽

Vol 67 (3) ◽

Author(s):

BLANCA E DEL RIO NAVARRO ◽

Omar Josúe Saucedo Ramírez ◽

Joaquín A. Pimentel Hayashi

Keyword(s):

Food Allergy ◽

Food Challenge ◽

Elimination Diet ◽

Oral Immunotherapy ◽

Industrialized Countries ◽

Double Blind ◽

Immunological Mechanisms ◽

Hen’S Egg ◽

Ige Mediated

Food allergy is an immune reaction that occurs frequently in pediatric age, its prevalence is higher in industrialized countries, affecting 8% of the population, the most frequently involved foods are milk, hen’s egg, soybeans, peanuts, fish, wheat, seafood and tree nuts. Food allergy can be divided into three groups: IgE-mediated, non-IgE-mediated, and mixed food allergy. The symptoms will depend on the immunological mechanisms and can be divided into immediate or no immediate, the immediate symptoms appear in the first two hours of intake and the no immediate symptoms after the second hour and up to 72 hours. Diagnosis of food allergy requires a medical history, physical examination and laboratory tests; misdiagnosis can lead to unnecessary elimination diets. The gold standard is the double-blind placebo controlled oral food challenge. The main treatment is food restriction, the nutritional and psychological implications that this entails must be taken into account; Another treatment option is oral immunotherapy, it is recommended in patients who cannot carry out an elimination diet and it has a significant impact on quality of life.

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Efficacy and safety of allergen immunotherapy for IgE-mediated food allergy: systematic review and meta-analysis

10.22541/au.163700696.66686852/v1 ◽

2021 ◽

Author(s):

Debra de Silva ◽

Pablo Rodriguez del Rio ◽

Nicolette w Jong ◽

Ekaterina Khaleva ◽

C. Singh ◽

...

Keyword(s):

Food Allergy ◽

Adverse Reactions ◽

Meta Analysis ◽

Oral Immunotherapy ◽

Cow’S Milk ◽

Egg Allergy ◽

Efficacy And Safety ◽

Cow's Milk ◽

Hen’S Egg ◽

Ige Mediated

Background There is substantial interest in allergen-specific immunotherapy in food allergy. We systematically reviewed its efficacy and safety. Methods We searched six bibliographic databases from 1946 to 30 April 2021 for randomised controlled trials about immunotherapy alone or with biologicals in IgE-mediated food allergy confirmed by oral food challenge. We pooled the data using random-effects meta-analysis. Results We included 36 trials with 2,126 participants, mainly children. Oral immunotherapy increased tolerance whilst on therapy for peanut (RR 9.9, 95% CI 4.5. to 21.4, high certainty); cow’s milk (RR 5.7, 1.9 to 16.7, moderate certainty) and hen’s egg allergy (RR 8.9, 4.4 to 18, moderate certainty). The number needed to treat to increase tolerance to a single dose of 300mg or 1000mg peanut protein was 2. In peanut allergy, oral immunotherapy did not increase adverse reactions (RR 1.1, 1.0 to 1.2, low certainty) or severe reactions (RR 1,6, 0.7 to 3.5, low certainty). It may increase adverse reactions in cow’s milk (RR 3.9, 2.1 to 7.5, low certainty) and hen’s egg allergy (RR 7.0, 2.4 to 19.8, moderate certainty), but reactions tended to be mild and gastrointestinal. Epicutaneous immunotherapy increased tolerance whilst on therapy for peanut (RR 2.6, 1.8 to 3.8, moderate certainty). Results were unclear for other allergies and administration routes. Conclusions Oral immunotherapy improves tolerance whilst on therapy and is probably safe in peanut, cow’s milk and hen’s egg allergy. However, our review found little about whether this improves quality of life, is sustained or cost-effective.

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Updates on Food Allergy, Increasingly Prevalent Challenge

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.10.3.2018.21980 ◽

2018 ◽

Vol 10 (3) ◽

pp. 152

Author(s):

Tonny Tanus ◽

Sunny Wangko

Keyword(s):

Atopic Dermatitis ◽

Food Allergy ◽

Eosinophilic Esophagitis ◽

Immunoglobulin E ◽

Pediatric Population ◽

Food Allergies ◽

Food Protein ◽

Safety Issues ◽

Ige Mediated ◽

Allergic Disorders

Abstrak: Prevalensi alergi makanan makin meningkat di seluruh dunia dan mengenai semua usia. Keparahan dan kompleksitas penyakit juga meningkat terlebih pada populasi anak. Terdapat beberapa jenis reaksi alergi yang dibahas: immunoglobulin E (IgE) mediated allergies and anaphylaxis, food triggered atopic dermatitis, eosinophilic esophagitis, dan non IgE mediated gastrointestinal food allergic disorders seperti food protein induced enterocolitis syndrome (FPIEs). Tes alergi, baik melalui kulit maupun IgE yang telah dikerjakan sekian lama masih dibebani dengan hasil positif palsu dan negatif palsu yang bermakna dengan manfaat terbatas pada beberapa alergi makanan. Selain menghindari, tidak terdapat terapi yang ampuh untuk alergi makanan. Berbagai imunoterapi telah dipelajari melalui jalur, subkutan, epikutan, oral dan sublingual yang hanya menghasilkan desensitisasi sementara dan dibebani dengan berbagai isu mengenai keamanannya. Agen biologik yang menghambat sitokin/interleukin (IL) dan molekul pada reaksi alergi makanan tampaknya merupakan pilihan yang menjanjikan. Anti IgE telah dipergunakan pada asma dan urtikaria kronis. Anti IL-4 dan IL-13 yang menghambat produksi IgE diindikasikan untuk dermatitis atopik. Anti eosinofil anti IL-5 berhasil menurunkan eksaserbasi asma. Berbagai agen biologik telah dipelajari untuk berbagai kondisi alergik dan imunologik, tetapi efektivitas dan kepraktisan terapi yang mahal ini untuk alergi makanan masih menjadi tanda tanya.Kata kunci: alergi makanan, reaksi alergi, terapi alergi makananAbstract: Food allergies have been increasing in prevalence for years affecting all ages. Disease severity and complexity have also increased, especially in the pediatric population. There are several types of reactions including: immunoglobulin-E (IgE) mediated allergies and anaphylaxis, food-triggered atopic dermatitis, eosinophilic esophagitis, and non IgE mediated gastrointestinal food allergic disorders such as FPIEs. Though allergy testing has been around for years, both skin and IgE testing are burdened by significant false positives and negatives, and are only useful in some food allergies. Avoidance is the sole therapy for food allergy. A variety of immunotherapies have been studied; subcutaneous, epicutaneous, oral, and sublingual. At best they only produce a temporary state of desensitization and have many safety issues. Examples of biologicals which block critical cytokines/interleukins (IL) in allergic conditions are Anti IgE, anti IL-4 and IL-13, and Anti eosinophils, Anti IL-5. Other biologicals are being studied for allergic conditions, but whether these expensive future treatments will be proven effective and practical in food allergy is unknown.Keywords: food allergy, allergic reaction, food allergy therapy

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