404 Allergen Specific Immunotherapy as a Treatment for Eosinophilic Esophagitis

BACKGROUND: Eosinophilic Esophagitis (EoE) is an inflammatory disease that reduces the ability of the esophagus to pass food, often leading to dysphagia. A relationship between EoE and food allergies has been determined. However, there have been several documented cases in which patients had negative prick skin testing (PST) results for food allergens and positive results for airborne environmental allergens, and still have a confirmed diagnosis of EoE. Recently, airborne allergens have been implicated in the onset of this condition. Studies have shown that patients sensitive to airborne allergens such as pollen have a seasonal biannual component in which the severity of EoE symptoms increase, coinciding with high pollen seasons. METHODS: We followed a 65-year-old man with a history of allergies complaining of an increase in his symptoms of allergic rhinitis and asthma. He also noted dysphagia and occasional vomiting. We noted the disease and medication course over 5 years of treatment. RESULTS: The patient underwent an esophagogastroduodenoscopy with biopsy, in which midesophageal rings as well as an 8 mm sessile polyp were found, suggesting EoE. Histological analysis confirmed EoE, having found >20 intraepithelial eosinophils/HPF. The patient was treated with a short term prednisone regimen, as well as maintenance medications consisting of inhaled corticosteroids and antihistamines. The patient returned 6 months after the initial consultation and still presented symptoms of EoE, at which point the patient was prescribed proton pump inhibitors. In addition, allergen specific immunotherapy was initiated for confirmed airborne allergens. The patient was examined after 5 years of immunotherapy treatment. Not only did he report that his allergic rhinitis and asthma symptoms were controlled, but his EoE symptoms had resolved. CONCLUSIONS: Results suggest that immunotherapy for airborne allergens could be a successful treatment for EoE. A larger study is needed to determine if allergen specific immunotherapy is a viable treatment option for EoE in similar cases. Such a study could include patients with EoE and confirmed airborne allergies treated with immunotherapy while monitoring a number of eosinophilic and lymphocytic markers.