title: Eosinophilic esophagitis is characterized by a non-IgE-mediated food hypersensitivity.
abstract: Eosinophilic esophagitis (EoE) is a chronic disease characterized clinically by symptoms of esophageal dysfunction and histologically by eosinophil-predominant inflammation. EoE is frequently associated with concomitant atopic diseases and immunoglobulin E (IgE) sensitization to food allergens in children as well as to aeroallergens and cross-reactive plant allergen components in adults. Patients with EoE respond well to elemental and empirical food elimination diets. Recent research has, however, indicated that the pathogenesis of EoE is distinct from IgE-mediated food allergy. In this review, we discuss the individual roles of epithelial barrier defects, dysregulated innate and adaptive immune responses, and of microbiota in the pathogenesis of EoE. Although food has been recognized as a trigger factor of EoE, the mechanism by which it initiates or facilitates eosinophilic inflammation appears to be largely independent of IgE and needs to be further investigated. Understanding the pathogenic role of food in EoE is a prerequisite for the development of specific diagnostic tools and targeted therapeutic procedures.
authors.affiliation: Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Simon
authors.affiliation: Division of Allergy and Immunology, Children's Hospital Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.|Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Cianferoni
authors.affiliation: Division of Allergy and Immunology, Children's Hospital Philadelphia, University of Pennsylvania, Philadelphia, PA, USA.|Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Spergel
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics and Medicine, Center for Infection, Inflammation, and Immunology, La Jolla, CA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Aceves
authors.affiliation: Allergy and Asthma Consultants, Indianapolis, IN, USA.
authors.forename: M
authors.initials: M
authors.lastname: Holbreich
authors.affiliation: Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.|School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.
authors.forename: C
authors.initials: C
authors.lastname: Venter
authors.affiliation: Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: Rothenberg
authors.affiliation: Department of ENT and Pediatrics, AMC, Amsterdam, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Terreehorst
authors.affiliation: Food Allergy Referral Centre Veneto Region, Padua General University Hospital, Padua, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Muraro
authors.affiliation: Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.
authors.forename: A J
authors.initials: AJ
authors.lastname: Lucendo
authors.affiliation: Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois/CHUV, Lausanne, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Schoepfer
authors.affiliation: Swiss EoE Research Network, Olten, Switzerland.
authors.forename: A
authors.initials: A
authors.lastname: Straumann
authors.affiliation: Institute of Pharmacology, University of Bern, Bern, Switzerland.
authors.forename: H-U
authors.initials: HU
authors.lastname: Simon
mesh_terms: D000485:Allergens / Q000276:immunology; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D057765:Eosinophilic Esophagitis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology* / Q000378:metabolism; D004848:Epithelium / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D005502:Food / Q000009:adverse effects; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000209:etiology* / Q000378:metabolism; D006801:Humans; D006967:Hypersensitivity / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D007113:Immunity, Innate; D007073:Immunoglobulin E / Q000276:immunology; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000209:etiology / Q000378:metabolism; D000069444:Omalizumab / Q000627:therapeutic use; D012867:Skin / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D018418:Th2 Cells / Q000276:immunology / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D000485:Allergens; D018927:Anti-Asthmatic Agents; D000069444:Omalizumab; D007073:Immunoglobulin E
keywords: eosinophilic esophagitis; epithelial barrier; food allergy; immune response; immunoglobulin E