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Eosinophil-Associated Gastrointestinal Manifestations During OIT.

Michael R Goldberg1,2, Naama Epstein-Rigbi3,4, Arnon Elizur3,4

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Oral immunotherapy (OIT) for food allergies can cause gastrointestinal issues. This review details two types of non-anaphylactic eosinophil-associated gastrointestinal events during OIT, guiding their distinct management strategies.

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Area of Science:

  • Gastroenterology
  • Allergy and Immunology
  • Clinical Therapeutics

Background:

  • Gastrointestinal adverse events are frequent during oral immunotherapy (OIT) for food allergies.
  • These events range from immediate IgE-mediated reactions to non-anaphylactic presentations.
  • This review focuses on non-anaphylactic eosinophil-associated gastrointestinal adverse events during OIT.

Purpose of the Study:

  • To summarize recent findings on non-anaphylactic eosinophil-associated gastrointestinal adverse events during OIT.
  • To differentiate between two clinical presentations based on onset and treatment.
  • To identify risk factors and management strategies for these events.

Main Methods:

  • Review of recent literature on OIT-induced gastrointestinal adverse events.
  • Identification and categorization of non-anaphylactic eosinophil-associated events.
  • Analysis of clinical presentations, biomarkers, and treatment responses.

Main Results:

  • Two distinct clinical presentations of non-anaphylactic eosinophil-associated gastrointestinal adverse events were identified.
  • Early-onset events (weeks to months) involve abdominal pain, nausea, vomiting, and potentially rising absolute eosinophil counts (AEC), managed by dose adjustment.
  • Late-onset events (months to years) present as eosinophilic esophagitis (EoE), treated with standard EoE therapies.

Conclusions:

  • Non-anaphylactic eosinophil-associated gastrointestinal adverse events during OIT have distinct early and late presentations.
  • Management strategies differ based on the clinical presentation and onset.
  • Most patients can continue OIT with appropriate management of these adverse events.