title: The management of eosinophilic esophagitis.
abstract: Eosinophilic esophagitis (EoE) is a clinicopathologic, chronic esophageal inflammatory disease resistant to acid suppressive therapy and is associated with variable symptoms indicative of upper gastrointestinal dysfunction. Per current guidelines established by The International Group of Eosinophil Researchers (TIGERS), the diagnosis is made in symptomatic patients after a biopsy that confirms a peak eosinophil level of ≥15 eosinophils/high-powered field (HPF). The esophagus is distinguished by pronounced tissue eosinophilia in which dietary antigens are key inciting factors for disease pathogenesis; EoE being reversed by elimination of triggering food allergens suggests that the disease is mediated in part by allergic sensitization to foods. Moreover, experimental EoE in mice can be induced not only via food exposure but also via aeroallergen exposure. Consistent with an allergic etiology rather than an acid-induced esophagitis, swallowed glucocorticoids are effective for the treatment of EoE. Evaluation by an allergist is a recommended part of the diagnostic workup, especially for management of allergic comorbidities. Clinical practice for the evaluation of patients with EoE mainly relies on prick skin tests due to the ease and validation of these tests in the context of immediate hypersensitivity. However, both atopy patch testing and serum IgE testing have been used in EoE. Herein, we reviewed the basic clinical features of EoE with a focus on the approach to diagnosing causative food allergens and to dietary therapy.
authors.affiliation: Assistant Professor, Division of Allergy and Clinical Immunology, University of Michigan Food Allergy Center, University of Michigan Medical School, University of Michigan Health System, Ann Arbor, Mich.
authors.forename: Matthew
authors.initials: M
authors.lastname: Greenhawt
authors.affiliation: Associate Professor, Pediatrics and Medicine, Division of Allergy and Immunology; Director, Eosinophilic Gastrointestinal Disorders Clinic, University of California, San Diego, Rady Children's Hospital, San Diego, Calif.
authors.forename: Seema S
authors.initials: SS
authors.lastname: Aceves
authors.affiliation: Professor of Pediatrics, Chief, Allergy Section, Codirector, Center for Pediatric Eosinophilic Gastrointestinal Disorders, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Spergel
authors.affiliation: Professor of Pediatrics, Director, Division of Allergy and Immunology; Director, Cincinnati Center for Eosinophilic Disorders, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address: Marc.Rothenberg@cchmc.org.
authors.forename: Marc E
authors.initials: ME
authors.lastname: Rothenberg
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000465:Algorithms; D000818:Animals; D004032:Diet; D018450:Disease Progression; D057765:Eosinophilic Esophagitis / Q000175:diagnosis / Q000628:therapy*; D006801:Humans
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Atopy patch testing; Dietary management; Elemental diet; Elimination diet; Empiric diet; Eosinophil; Eosinophilic esophagitis; Six-food elimination diet; Skin testing; Swallowed steroid therapy; Targeted elimination diet