Allergic components of eosinophilic esophagitis

Area of Science:

• Gastroenterology
• Allergology
• Immunology

Background:

• Eosinophilic esophagitis (EoE) is a prevalent esophageal disorder characterized by eosinophil infiltration.
• EoE shares a T_H2 cytokine profile with other allergic conditions like asthma and atopic dermatitis.
• Environmental antigens trigger immune cell infiltration and epithelial activation in the esophagus.

Purpose of the Study:

• To elucidate the pathogenesis of eosinophilic esophagitis.
• To highlight the role of environmental antigens and T_H2 inflammation in EoE.
• To emphasize the connection between EoE and other atopic disorders.

Main Methods:

• Molecular profiling to identify EoE's characteristic T_H2 cytokine profile.
• Analysis of immune cell infiltration (eosinophils, basophils, mast cells, T-cells) in response to environmental antigens.
• Observation of esophageal remodeling and comparison to asthmatic airway pathogenesis.

Main Results:

• EoE is an eosinophil-predominant disorder with a T_H2 immune response.
• Local epithelial immune activation involves thymic stromal lymphopoietin and eotaxin-3.
• Disease resolution occurs in over 50% of patients upon removal of inciting antigens, particularly foods.

Conclusions:

• Antigen removal, especially dietary, is crucial for EoE management.
• Testing for allergens and treating the whole atopic patient is essential.
• Understanding the interplay between organ-specific allergic responses is key to controlling EoE.