Immunology of eosinophilic esophagitis: Clues to the solution of a mystery
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Medical School, University of Cyprus, Nicosia, Cyprus
Publication date: 2022-05-27
Public Health Toxicol 2022;2(Supplement Supplement 1):A38
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus. EoE’s main symptoms in infants are vomiting, failure to thrive and food refusal, in school-age children difficulty in swallowing, vomiting and food impaction, while heartburn and chest pain are the main symptoms in puberty and adulthood1. The clinical experience has connected EoE to causative foods, different for each patient. EoE is related to atopic diseases such as IgE-mediated food allergy. The results of in vitro and in vivo food allergy tests have been used to design “tailored-made” diets for the treatment of EoE. However, this dietary approach was not shown to be more efficient than other dietary strategies, based on the use of elemental formulas, or on the empiric elimination of foods2. The immunological paradox of EoE connection to causative foods and to the concomitant allergic diseases, without a direct IgE-mediated mechanism, is not completely cleared. The activation of T cells with TH-2 cytokines noticed in EoE can be a systemic phenomenon that downregulates the esophageal barrier3. The increased permeability of esophagus is leading to the establishment of sensitization to food allergens, explaining the connection of EoE exacerbation to their dietary reintroduction.
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