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Gastrointestinal Eosinophilic Diseases: Updates on Eosinophilic Esophagitis and Eosinophilic Gastrointestinal Diseases
Fifteen years after the last issue of Immunology and Allergy Clinics of North America on this topic, eosinophilic gastrointestinal diseases (EGIDs) continue to capture the attention of allergists/immunologists, gastroenterologists, pathologists, dietitians, speech therapists, and psychologists. Our understanding of the pathogenesis and clinical aspects of eosinophilic esophagitis (EoE) has advanced rapidly, whereas knowledge regarding the lower-tract EGIDs (eosinophilic gastritis [EoG], eosinophilic enteritis [EoN], eosinophilic colitis [EoC]) has accumulated at a slower, albeit increasing, pace. (Source: Immunology and Al...
Source: Immunology and Allergy Clinics of North America - February 13, 2024 Category: Allergy & Immunology Authors: Glenn T. Furuta, Dan Atkins Tags: Preface Source Type: research

Dietary Management of Non-EoE Eosinophilic Gastrointestinal Diseases
Patients with non –eosinophilic esophagitis eosinophilic gastrointestinal diseases (non-EoE EGIDs) are prone to nutritional deficiencies due to food-avoidant behaviors, malabsorption, and high nutrition impact symptoms. Nutrient deficiencies correspond to the segment, depth, and extent of the gastrointestinal tract involved and can impact organs distant from the gut. Patients with non-EoE EGIDs are often atopic, and some appear to respond to dietary avoidance of specific food allergens. Tests to identify food triggers other than response to elimination diets are lacking. Dietary restriction therapy should be considered i...
Source: Immunology and Allergy Clinics of North America - February 12, 2024 Category: Allergy & Immunology Authors: Mirna Chehade, Bethany Doerfler, Dan Atkins Source Type: research

Pharmacologic Management of Non –Eosinophilic Esophagitis Eosinophilic Gastrointestinal Diseases
Data for pharmacologic treatments for non –eosinophilic esophagitis (EoE) eosinophilic gastrointestinal diseases (EGIDs) are limited. Nevertheless, because of the increasing understanding of EGID pathogenesis, a number of medications are used to treat EGIDs, though all are currently off-label. Initial therapy generally starts with cortico steroids, and “topical” delivery is preferred over systemic due to long-term side effects. A number of other small molecules could potentially be used, ranging from allergy medications to immunosuppressants. Biologics are also being used and investigated for EGIDs and represent prom...
Source: Immunology and Allergy Clinics of North America - February 10, 2024 Category: Allergy & Immunology Authors: Evan S. Dellon, Sandeep K. Gupta Source Type: research

Health-Related Quality of Life in Patients with Eosinophilic Esophagitis
Measuring health-related quality of life (HRQOL) gained relevance in research and clinical practice in patients with eosinophilic esophagitis. The physical discomfort and social and psychological consequences of this food-related disease substantially affect HRQOL. Determinant of an impaired HRQOL include symptom severity, disease duration, biological disease activity, and psychological factors. Patients prioritize symptom relief and improved HRQOL as treatment objectives. Available treatment options can address these goals; however, there is a suboptimal adherence to treatment. There is a need for enhanced patient guidanc...
Source: Immunology and Allergy Clinics of North America - February 7, 2024 Category: Allergy & Immunology Authors: Maria L. van Klink, Albert J. Bredenoord Source Type: research

Pharmacologic Management of Eosinophilic Esophagitis
Proton pump inhibitors (PPIs), swallowed topical corticosteroids (STSs), and dupilumab are highly effective therapies for the treatment of eosinophilic esophagitis. Shared decision-making informs the choice of therapy and factors such as ease of use, safety, cost, and efficacy should be addressed. PPIs are the most common medication utilized early in the disease course; however, for nonresponders, STSs are an excellent alternative. Dupilumab is unlikely to replace PPIs or STSs as first-line therapy, except in highly specific circumstances. Identification of novel biologic pathways and the development of small molecules may...
Source: Immunology and Allergy Clinics of North America - January 23, 2024 Category: Allergy & Immunology Authors: Gary W. Falk, Robbie Pesek Source Type: research

Histopathology of Eosinophilic Esophagitis
Microscopic examination of esophageal biopsies is essential to diagnose eosinophilic esophagitis (EoE). Eosinophil inflammation is the basis for the diagnosis, but additional abnormalities may contribute to persistent symptoms and epithelial barrier dysfunction. Both peak eosinophil count and assessments of additional features should be included in pre-therapy and post-therapy pathology reports. Pathologic abnormalities identified in esophageal biopsies of EoE are reversible in contrast to esophageal strictures. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - January 16, 2024 Category: Allergy & Immunology Authors: Margaret H. Collins, Nicoleta C. Arva, Anas Bernieh, Oscar Lopez-Nunez, Maria Pletneva, Guang-Yu Yang Source Type: research

Epidemiologic and Clinical Clues to the Etiology of Eosinophilic Esophagitis
Despite the rising prevalence and incidence of eosinophilic esophagitis (EoE), the etiology and pathophysiology remain unknown. Studies to date suggest that complex interactions between genetic and environmental risk factors result in the development and presentation of disease. Examining environmental factors both in the early life and later life exposures offers potential clues for the development of EoE, although challenges exist in making causal inferences due to diagnostic delay and access, ascertainment biases, and misclassification of cases. The authors review studies supporting early life factors as etiologic facto...
Source: Immunology and Allergy Clinics of North America - January 13, 2024 Category: Allergy & Immunology Authors: Joy W. Chang, Elizabeth T. Jensen Source Type: research

Pathophysiology and Clinical Impact of Esophageal Remodeling and Fibrosis in Eosinophilic Esophagitis
Most of the major clinical signs and consequences of eosinophilic esophagitis seem to be related to tissue remodeling. Important data on remodeling activity in patients with eosinophilic esophagitis are provided by a range of current and new biologic markers and diagnostics. To completely clarify the possible advantages and restrictions of therapeutic approaches, clinical studies should take into consideration the existence and reversibility of esophageal remodeling. The degree of mucosal or submucosal disease activity may not be reflected by epithelial eosinophilic inflammation, which is used to define one criterion of di...
Source: Immunology and Allergy Clinics of North America - January 12, 2024 Category: Allergy & Immunology Authors: Calies Menard-Katcher, Seema Aceves Source Type: research

Endoscopic Features of Eosinophilic Esophagitis
Edema, rings, exudates, furrows, and strictures (EREFS) represent the major endoscopic features of eosinophilic esophagitis (EoE). The Endoscopic Reference System (EREFS) grading system is easy to learn and apply during daily clinical practice in the diagnosis and follow-up of EoE patients. When endoscopy is performed by an EoE-experienced physician, the EREFS criteria will identify the majority of EoE patients. The EREFS score from the area of greatest involvement of the esophagus should be reported. The EREFS grading system was formally validated as an endoscopy score and several randomized placebo-controlled trials have...
Source: Immunology and Allergy Clinics of North America - January 12, 2024 Category: Allergy & Immunology Authors: Alain M. Schoepfer, Ekaterina Safroneeva, Kathryn Peterson Source Type: research

Clinical Evaluation of the Adult with Eosinophilic Esophagitis
Adult patients with eosinophilic esophagitis (EoE) typically present with a history of dysphagia for solids, sometimes with additional reflux-like pain and a history of prior food impactions. In contrast to these alarming symptoms, the general appearance and physical examination of adult patients with EoE is in line with apparently healthy individuals. Therefore, the diagnosis is based on a history of solid-food dysphagia and eosinophilic tissue infiltration. Importantly, the increasing prevalence of EoE variants, that is, typical EoE symptoms in the absence of a relevant eosinophilia, and several studies with eosinophil-t...
Source: Immunology and Allergy Clinics of North America - January 10, 2024 Category: Allergy & Immunology Authors: Luc Biedermann, Alex Straumann Source Type: research

Pathophysiology of Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE) is a chronic, progressive immune-mediated disease associated with antigen-driven type 2 inflammation and symptoms of esophageal dysfunction. Research over the last 2  decades has dramatically furthered our understanding of the complex interplay between genetics, environmental exposures, and cellular and molecular interactions involved in EoE. This review provides an overview of our current understanding of EoE pathogenesis. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - January 9, 2024 Category: Allergy & Immunology Authors: Kanak V. Kennedy, Amanda B. Muir, Melanie A. Ruffner Source Type: research

Clinical Evaluation of the Child with Eosinophilic Esophagitis
The diagnosis of eosinophilic esophagitis (EoE) is based on clinical symptoms of esophageal dysfunction and eosinophil predominant esophageal inflammation. Clinical symptoms in children with EoE vary based on age and may be nonspecific. EoE has a male predominance with the majority having comorbid atopic disorders. At present, treatment options include medications (proton pump inhibition, swallowed topical steroids), dietary therapy or biologic therapy (dupilumab, approved for those ≥12 years of age). Outside of EoE in the context of oral immunotherapy, EoE is typically chronic requiring lifelong therapy. Long-term comp...
Source: Immunology and Allergy Clinics of North America - January 9, 2024 Category: Allergy & Immunology Authors: Maureen Bauer, Nathalie Nguyen, Chris A. Liacouras Source Type: research

Recognition and Management of Feeding Dysfunction in the Pediatric Patient with Eosinophilic Esophagitis
Feeding is a complex skill requiring coordination of multiple body systems. Multiple factors are considered in feeding dysfunction in pediatric patients with eosinophilic gastrointestinal disorders, including overall development, nutritional status, mealtime behaviors, and medical comorbidities. Symptoms of feeding dysfunction vary by age, with maladaptive learned feeding behaviors spanning all age ranges. Knowledge of the normal acquisition of feeding skills is critical to interpret the impact of the disease and plan appropriate intervention. Assessment and treatment from a feeding and swallowing disorders specialist can ...
Source: Immunology and Allergy Clinics of North America - January 9, 2024 Category: Allergy & Immunology Authors: Angela M. Haas, Rebecca J. Doidge, Girish Hiremath Source Type: research

Impact of Climate Change on Dietary Nutritional Quality and Implications for Asthma and Allergy
This article discusses asthma epidemiology and the influence of global climate change. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - November 15, 2023 Category: Allergy & Immunology Authors: Kecia N. Carroll Source Type: research

Growing Impact of Climate Change on Respiratory Health and Related Allergic Disorders: Need for Health Systems to Prepare
The World Health Organization has identified climate change as the biggest health threat facing humanity.1 The days of a polar bear stranded on an ice flow as the icon of global warming have passed. What scientists have predicted for decades has now become a reality. We are now witnessing the growing impact on human health as a result of our changing climate, our warming planet, and continued increase in greenhouse gas emissions. (Source: Immunology and Allergy Clinics of North America)
Source: Immunology and Allergy Clinics of North America - November 15, 2023 Category: Allergy & Immunology Authors: Rosalind J. Wright, Jeffrey G. Demain Tags: Preface Source Type: research