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Eosinophilic esophagitis during sublingual and oral allergen immunotherapy

Cafone, Josepha; Capucilli, Petera; Hill, David A.a,b; Spergel, Jonathan M.a,b

Current Opinion in Allergy and Clinical Immunology: August 2019 - Volume 19 - Issue 4 - p 350–357
doi: 10.1097/ACI.0000000000000537
PHARMACOTHERAPY AND EVIDENCE BASED MEDICINE: Edited by Enrico Compalati and Ignacio J. Ansotegui
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Purpose of review The aim of this review is to discuss the current evidence regarding the development of eosinophilic esophagitis (EoE) in individuals undergoing oral and sublingual immunotherapy (SLIT) for both food and environmental allergens. Cumulative incidence of EoE in patients on allergen immunotherapy for peanut, milk, and egg is estimated.

Recent findings De novo development of EoE in patients undergoing oral and SLIT has been demonstrated on the scale of case reports and prospective randomized trials. However, few individuals with EoE-like symptoms during immunotherapy undergo endoscopy, and the long-term outcomes of immunotherapy-associated EoE are unknown.

Summary Evidence exists to suggest that allergen immunotherapy could place individuals at risk for the development of EoE, the true incidence of which may vary depending on antigen exposure and methods used to define the condition.

aDivision of Allergy and Immunology, Department of Pediatrics, Children's Hospital of Philadelphia

bDepartment of Pediatrics, Institute for Immunology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA

Correspondence to Jonathan M. Spergel, MD, PhD, Division of Allergy and Immunology, Children's Hospital of Philadelphia, The Wood Building, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA. Tel: +1 215 590 2549; fax: +1 215 590 6849; e-mail: spergel@email.chop.edu

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