Immunotherapeutic approaches for the treatment of eosinophilic esophagitis.
Eosinophilic esophagitis (EoE) is a clinical pathologic disease characterized by symptoms of esophageal dysfunction and eosinophilia of the esophagus. When the diagnosis is confirmed, it is important to treat the eosinophilic inflammation not only to control the presenting symptoms, but also to prevent acute and chronic complications. The pathogenesis of EoE is most likely a mixed IgE and non-IgE food-mediated reaction, where Th2 cytokines drive esophageal eosinophilia as in other atopic diseases. Hence, it is not surprising that therapy is based on inflammation control, with steroids (oral or topical) and/or food antigen avoidance. However, these treatment options are not specific, reduce the quality of life of patients and have significant side effects, therefore, there is an ongoing effort to design more specific immunotherapies. In this review, we review standard and immunotherapeutic options for EoE treatment, such as anti-IL-5, anti-TNFα, anti-IgE, anti-CRTH, oral allergy desensitization and environmental immunotherapy.
Divisions of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, ARC 1216H, 3615 Civic Center Blvd, Philadelphia, PA 19104, USA.
Antonella
A
Cianferoni
Jonathan M
JM
Spergel
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000485:Allergens / Q000009:adverse effects / Q000627:therapeutic use; D000818:Animals; D000888:Antibodies, Anti-Idiotypic / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000276:immunology / Q000627:therapeutic use; D000918:Antibody Specificity; D003131:Combined Modality Therapy; D016207:Cytokines / Q000235:genetics / Q000276:immunology / Q000502:physiology; D003888:Desensitization, Immunologic; D003937:Diagnosis, Differential; D057765:Eosinophilic Esophagitis / Q000175:diagnosis / Q000178:diet therapy / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D005512:Food Hypersensitivity / Q000276:immunology; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007167:Immunotherapy / Q000379:methods*; D015848:Interleukin-5 / Q000037:antagonists & inhibitors / Q000502:physiology; D051379:Mice; D011971:Receptors, Immunologic / Q000037:antagonists & inhibitors / Q000276:immunology; D011982:Receptors, Prostaglandin / Q000037:antagonists & inhibitors / Q000276:immunology; D018418:Th2 Cells / Q000276:immunology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D000094632:Thymic Stromal Lymphopoietin
D000305:Adrenal Cortex Hormones; D000485:Allergens; D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D016207:Cytokines; C508599:IL5 protein, human; D007166:Immunosuppressive Agents; D015848:Interleukin-5; D011971:Receptors, Immunologic; D011982:Receptors, Prostaglandin; D014409:Tumor Necrosis Factor-alpha; C026408:anti-IgE antibodies; D007073:Immunoglobulin E; C036293:prostaglandin D2 receptor; D000094632:Thymic Stromal Lymphopoietin