Esophageal dysfunction and immunological changes induced by grass sublingual immunotherapy.

Area of Science:

• Immunology
• Allergology
• Gastroenterology

Background:

• Sublingual immunotherapy (SLIT) is a common treatment for allergic rhinoconjunctivitis.
• Oropharyngeal adverse events are typical but usually mild and self-limiting.
• Immunological mechanisms involve shifts in immunoglobulin G4 (IgG4) and immunoglobulin E (IgE) responses.

Observation:

• A 25-year-old male with grass pollen allergy experienced severe esophageal dysfunction after initiating Phleum pratense SLIT.
• Symptoms occurred immediately post-administration, resolved spontaneously, and ceased upon treatment discontinuation.
• This coincided with a significant elevation in total and specific IgE levels.

Findings:

• The patient's esophageal symptoms were temporally associated with SLIT initiation.
• Elevated IgE levels suggest a potential role in the observed adverse event.
• Immunological changes, including IgE fluctuations, gradually normalized over three years post-therapy.

Implications:

• This case suggests a potential link between SLIT-induced immunological changes and esophageal dysfunction.
• Further research is needed to understand the role of specific immunological shifts in SLIT-related esophageal disorders.
• Clinicians should consider esophageal symptoms as a potential adverse event in patients undergoing SLIT, particularly with Phleum pratense.