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Periostin: Only a tissue biomarker in eosinophilic esophagitis assessment?
We read with great interest the article by Muir et  al1 in the Journal of Allergy and Clinical Immunology. By using the Esophageal String Test (EST), Muir et al1 highlight the key role of endoluminal periostin (POSTN) in tissue remodeling and fibrosis development in eosinophilic esophagitis (EoE). POSTN detection through EST seems to be a valuable alternative to invasive endoscopy; nevertheless, routinely adopting EST in the clinical care setting remains challenging.
Source: Journal of Allergy and Clinical Immunology - September 30, 2022 Category: Allergy & Immunology Authors: Sara Urbani, Eleonora Nucera, Alessandro Giovanni Fiocchi, Maurizio Mennini Tags: Correspondence Source Type: research

Esophageal remodeling in Eosinophilic Esophagitis: Relationships to luminal captured biomarkers of inflammation and periostin
Esophageal remodeling is a factor in disease progression and symptom severity for patients with Eosinophilic Esophagitis (EoE). Remodeling can begin early in children, resulting in stricture and food impaction. Detection of esophageal remodeling often depends on endoscopy and appreciated only in its later stages.
Source: Journal of Allergy and Clinical Immunology - April 7, 2022 Category: Allergy & Immunology Authors: Amanda Muir, Steven J. Ackerman, Zhaoxing Pan, Alain Benitez, Cassandra Burger, Jonathan M. Spergel, Glenn T. Furuta, Joshua Rothman, Benjamin J. Wilkins, Michael Arnold, Lauren Dolinsky, Milica Grozdanovic, Calies Menard-Katcher Source Type: research

The Minimally Invasive 1-Hr Esophageal String Test (EST) Monitors Changes in Mucosal Inflammation in Pediatric and Adult Eosinophilic Esophagitis Patients During Treatment
Endoscopy with biopsy is standard-of-care for monitoring Eosinophilic Esophagitis (EoE) activity. To assess resolution of mucosal inflammation after treatment, repeat endoscopies are necessary but burdensome due to anaesthesia, cost, time and impact on quality-of-life. The 1-hr EST, a validated minimally invasive swallowed string-containing capsule in children and adults, quantifies esophageal inflammation in patients with active EoE or in remisison.
Source: Journal of Allergy and Clinical Immunology - February 1, 2022 Category: Allergy & Immunology Authors: Steven Ackerman, Amir Kagalwalla, Joshua Wechsler, Kaitlin Keeley, Nirmala Gonsalves, Ikuo Hirano, Angelika Zalewski, Paul Paul Menard-Katcher, Nikhil Chauhan, Milica Grozdanovic, Glenn Furuta Source Type: research

Development of an Antigen-Specific T Cell Assay to Identify Food Triggers in Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE) is a chronic, T cell mediated disease that is triggered by specific foods and results in odynophagia and progressive esophageal dysfunction. Due to the absence of food-specific IgE antibodies in some EoE patients, skin prick testing is not reliably helpful when attempting to identify EoE-causal foods. As such, the current standard of care involves empiric food elimination diets or swallowed steroids with repeated endoscopies. There is significant need for a quick, non-invasive laboratory test which can accurately predict tolerated and trigger foods in EoE patients.
Source: Journal of Allergy and Clinical Immunology - February 1, 2021 Category: Allergy & Immunology Authors: Julianna Dilollo, Elizabeth Martin, David Hill, Jonathan Spergel Source Type: research

Eosinophil paradox with mepolizumab in chronic rhinosinusitis with nasal polyposis
We were intrigued to read the post hoc analysis by Howarth et  al1 suggesting that 100 mg mepolizumab given subcutaneously may reduce disease burden in the upper and lower airways of patients with severe eosinophilic asthma and chronic rhinosinusitis with nasal polyposis (CRSwNP). Pointedly, the diagnosis of CRSwNP was not based on either sinonasal endoscopy or computed tomography scan. The subgroup of patients in the MUSCA trial who completed the 22-item Sino-Nasal Outcome Test (SNOT-22) exhibited a mean treatment effect of −11.8 with mepolizumab, which exceeded the minimal clinically important difference of −8.9.
Source: Journal of Allergy and Clinical Immunology - July 24, 2020 Category: Allergy & Immunology Authors: Brian Lipworth, Rory Chan, Chris RuiWen Kuo Tags: Correspondence Source Type: research

Dietary therapy for eosinophilic esophagitis
Eosinophilic esophagitis is a chronic, immune-mediated esophageal disease triggered predominantly, but not exclusively, by food antigens. Presently, available food allergy tests are suboptimal to predict food triggers for eosinophilic esophagitis, especially in adults. Elemental diets (exclusive feeding with amino acid –based formulas) and empiric 6-food elimination diets (withdrawing milk, wheat, egg, soy, nuts, and fish/seafood for 6 weeks) have consistently shown the best efficacy rates. However, their high level of restriction and need for multiple endoscopies have hampered their implementation in clinical practice.
Source: Journal of Allergy and Clinical Immunology - March 6, 2018 Category: Allergy & Immunology Authors: Javier Molina-Infante, Alfredo J. Lucendo Tags: Current perspectives Source Type: research

Blood Eosinophil Beta1-Integrin Activation Correlates with Eosinophilic Esophagitis (EoE) Disease Activity
Monitoring of EoE would benefit from biomarkers to replace invasive endoscopy and pathology. We hypothesized that beta1-integrin activation, which enables arrest of eosinophils in inflamed vessels and predicts disease activity in non-severe asthma, correlates with eosinophilic inflammation and disease activity in EoE.
Source: Journal of Allergy and Clinical Immunology - February 1, 2018 Category: Allergy & Immunology Authors: Mats W. Johansson, Michael D. Evans, Elizabeth McKernan, Paul S. Fichtinger, Evelyn L. Angulo, Deane F. Mosher, Shelly M. Cook, Eric A. Gaumnitz, Sameer K. Mathur Source Type: research

Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: The 2-4-6 study
Numerous dietary restrictions and endoscopies limit the implementation of empiric elimination diets in patients with eosinophilic esophagitis (EoE). Milk and wheat/gluten are the most common food triggers.
Source: Journal of Allergy and Clinical Immunology - October 23, 2017 Category: Allergy & Immunology Authors: Javier Molina-Infante, Ángel Arias, Javier Alcedo, Ruth Garcia-Romero, Sergio Casabona-Frances, Alicia Prieto-Garcia, Ines Modolell, Pedro L. Gonzalez-Cordero, Isabel Perez-Martinez, Jose Luis Martin-Lorente, Carlos Guarner-Argente, Maria L. Masiques, Vi Tags: Food allergy and gastrointestinal disease Source Type: research

Eosinophilic esophagitis and colonic mucosal eosinophilia in Netherton syndrome
We report the presence of eosinophilic esophagitis and colonic mucosal eosinophilia in NS. Digestive endoscopies should be considered in NS patients with growth retardation and digestive symptoms.
Source: Journal of Allergy and Clinical Immunology - December 22, 2016 Category: Allergy & Immunology Authors: Colombe Paluel-Marmont, Nathalia Bellon, Patrick Barbet, St éphanie Leclerc-Mercier, Smail Hadj-Rabia, Christophe Dupont, Christine Bodemer Source Type: research

Eosinophil progenitor levels are increased in patients with active pediatric eosinophilic esophagitis
Eosinophilic esophagitis (EoE) is a chronic, food antigen–driven gastrointestinal disease characterized by marked esophageal eosinophilia. CCL26 (eotaxin-3) levels mediate eosinophil tissue recruitment,1,2 and eosinophil tissue counts serve as the basis for diagnosis.3 Currently, EoE treatment efficacy is often determined through invasive serial endoscopies with esophageal biopsies; thus, there is a compelling need to develop novel and less-invasive blood-based biomarkers to evaluate EoE disease activity.
Source: Journal of Allergy and Clinical Immunology - May 15, 2016 Category: Allergy & Immunology Authors: David W. Morris, Emily M. Stucke, Lisa J. Martin, J. Pablo Abonia, Vincent A. Mukkada, Philip E. Putnam, Marc E. Rothenberg, Patricia C. Fulkerson Tags: Letter to the Editor Source Type: research

Nasal endoscopy to characterize sinonasal disease
The data from Dixon et al1 suggest that using 100-200 μg/d intranasal mometasone spray does not improve asthma control in patients who also have sinonasal disease. Pointedly, no mention was made as to what instructions were given to patients regarding nasal spray technique. For example, patients with nasal polyposis and associated osteomeatal complex disease are unlikely to benefit from using a nasal spray with a technique that results in preferential deposition to the inferior turbinates. Moreover, higher doses of intranasal mometasone (ie, 400 μg/d) might be required to effectively treat nasal polyposis, along with co...
Source: Journal of Allergy and Clinical Immunology - May 7, 2015 Category: Allergy & Immunology Authors: Brian Lipworth Tags: Correspondence Source Type: research

Reply
We agree with Dr Lipworth1 that our study does not address whether treating complex sinonasal disease documented by endoscopy would affect asthma outcomes. This was not the purpose of our study. The purpose of our study was to determine whether treating chronic sinonasal disease in a diverse patient population in a manner analogous to that widely practiced in non–tertiary care specialty practices would improve asthma control.2
Source: Journal of Allergy and Clinical Immunology - May 7, 2015 Category: Allergy & Immunology Authors: Anne E. Dixon, Mario Castro, Rubin I. Cohen, Lynn B. Gerald, Janet T. Holbrook, Charles G. Irvin, Shyam Mohapatra, Stephen P. Peters, Sobharani Rayapudi, Elizabeth A. Sugar, Robert A. Wise, American Lung Association–Asthma Clinical Research Centers Tags: Correspondence Source Type: research

Four-food group elimination diet for adult eosinophilic esophagitis: A prospective multicenter study
Eosinophilic esophagitis (EoE) is an esophageal disorder predominantly triggered by food antigens. A six-food group elimination diet (SFGED) achieves remission in more than 70% of adult patients with EoE. After individual food reintroduction, just 1 or 2 food triggers for EoE can be identified in 65% to 85% of the patients, so some dietary restrictions and endoscopies after food challenge may be unnecessary.
Source: Journal of Allergy and Clinical Immunology - September 4, 2014 Category: Allergy & Immunology Authors: Javier Molina-Infante, Angel Arias, Jesus Barrio, Joaquín Rodríguez-Sánchez, Marta Sanchez-Cazalilla, Alfredo J. Lucendo Source Type: research

The Editors' Choice
Cow's milk is one of the most common foods causing eosinophilic esophagitis (EoE). Elimination of cow's milk from the diet is an effective nonpharmacologic treatment of cow's milk–mediated EoE (CMME). However, adherence to a milk-free diet is difficult because milk proteins are also present in baked foods, such as muffins, cakes, and breads. Studies show that a majority of children with IgE-mediated allergy to cow's milk can tolerate baked milk products, but it is not known whether patients with CMME can tolerate baked milk products. As reported in this issue, John Leung et al (p 1215) looked at the clinical outcome of...
Source: Journal of Allergy and Clinical Immunology - October 30, 2013 Category: Allergy & Immunology Authors: Donald Y.M. Leung, Stanley J. Szefler, Associate Editors of the JACI Tags: The Editors' choice Source Type: research

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