Primary eosinophilic gastrointestinal disorders in children who have received food oral immunotherapy.
BACKGROUND
Food oral immunotherapy (OIT) involves the administration of the food allergen causing the symptoms, in order to induce tolerance. Primary eosinophilic gastrointestinal disorders (PEGDs) are characterised by an eosinophil-rich inflammation affecting different locations of the digestive tract. We present a series of patients with PEGDs in a group of children following OIT with milk and/or egg.


METHODS
A prospective study during the period 2006-2014 was performed in paediatric patients subjected to OIT with milk and/or egg. When these children present persistent gastrointestinal symptoms, they are referred to the Paediatric Gastroenterology Unit for evaluation.


RESULTS
Primary eosinophilic gastrointestinal disorders were diagnosed in eight of the 128 cases of OIT (6.25%). The time to PEGDs development was variable: two cases showed symptoms during OIT, and the rest with a median time of 29 months (15-48 months). Food treatment discontinuation was not required in four of the five cases of eosinophilic oesophagitis, although food removal was necessary in patients with eosinophilic gastroenteritis.


CONCLUSIONS
We report the highest prevalence of PEGDs in children subjected to OIT, and the first cases of eosinophilic gastroenteritis following food OIT. The monitoring of new digestive signs and symptoms after OIT is crucial for the diagnosis of these disorders, and prolonged follow-up is required. The management of such patients and the need or not to eliminate the food should be assessed on an individualised basis, according to the severity of the condition, its evolution and response to different treatment alternatives.
Pediatric Allergy Unit, Severo Ochoa Universitary Hospital, Leganés, Spain. Electronic address: lecheverria333@gmail.com.
L Á
LÁ
Echeverría-Zudaire
Pediatric Gastroenterology Unit, Severo Ochoa Universitary Hospital, Leganés, Spain.
S
S
Fernández-Fernández
Pediatric Gastroenterology Unit, Severo Ochoa Universitary Hospital, Leganés, Spain.
A
A
Rayo-Fernández
Pediatric Allergy Unit, Villalba General Hospital, Villalba, Spain.
C
C
Muñóz-Archidona
Pediatric Gastroenterology Unit, Rey Juan Carlos Universitary Hospital, Móstoles, Spain.
R
R
Checa-Rodriguez
D000485:Allergens / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003888:Desensitization, Immunologic / Q000379:methods*; D004527:Egg Proteins / Q000276:immunology; D004751:Enteritis / Q000453:epidemiology* / Q000628:therapy; D004802:Eosinophilia / Q000453:epidemiology* / Q000628:therapy; D057765:Eosinophilic Esophagitis / Q000453:epidemiology* / Q000628:therapy; D004804:Eosinophils / Q000276:immunology*; D005500:Follow-Up Studies; D005512:Food Hypersensitivity / Q000453:epidemiology* / Q000628:therapy; D005756:Gastritis / Q000453:epidemiology* / Q000628:therapy; D041981:Gastrointestinal Tract / Q000276:immunology*; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000276:immunology; D008894:Milk Proteins / Q000276:immunology; D015995:Prevalence; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology
D000485:Allergens; D004527:Egg Proteins; D008894:Milk Proteins
Desensitization; Eosinophilic colitis; Eosinophilic esophagitis; Eosinophilic gastroenteritis; Food allergy; Food oral immunotherapy; Immunologic or immune tolerance