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- Page navigation anchor for Re: Monitoring for Eosinophilic Esophagitis in Food Oral ImmunotherapyRe: Monitoring for Eosinophilic Esophagitis in Food Oral Immunotherapy
Thank you for your inquiry regarding the long-term monitoring of children who undergo oral immunotherapy (OIT) for food allergies and the potential risk of developing eosinophilic esophagitis (EoE).
While there is evidence suggesting a link between OIT and EoE, particularly in atopic individuals, there is no current evidence to support increased risk of EoE development in patients who have completed OIT, who did not have symptom onset during treatment.EoE is considered an epithelial barrier disorder with increasing prevalence, and is strongly associated with atopic conditions including eczema, asthma, allergic rhinitis, and food allergy. The population undergoing OIT would therefore be considered at increased risk of EoE at baseline (1). Some individuals may have undiagnosed EoE prior to OIT initiation (2).
Studies have quoted that up to 2.7% of patients on OIT may develop EoE (3), with lower rates reported in a Canadian preschool cohort (4). EoE most often resolves upon discontinuation of therapy and may even be transient in the setting of long-term OIT (3).
The timing and clinical course of EoE onset relative to OIT completion make it exceedingly difficult to ascertain direct causality without large-scale, prospective studies involving invasive procedures like endoscopy, which pose ethical and practical challenges. This highlights the importance of thorough assessment and tailored management approaches during OIT, as outlined in studies advo...
Show MoreCompeting Interests: Samira Jeimy has been a member of advisory boards for Sanofi Genzyme, GSK, and ALK, received honoraria for speaking engagements from GSK and L’Oréal, and provided consultancy services for Canadian Agency for Drugs and Technologies in Health. Dr. Jeimy has leadership roles with the Ontario Medical Association and the Canadian Society of Allergy and Clinical Immunology. Edmond Chan has received research support from DBV Technologies; has been a member of advisory boards for Pfizer, Miravo, Medexus, Leo Pharma, Kaleo, DBV, AllerGenis, Sanofi Genzyme, Bausch Health, Avir Pharma, AstraZeneca, ALK, and Alladapt; and was co-lead of the Canadian Society of Allergy and Clinical Immunology (CSACI) oral immunotherapy guidelines. Dr. Chan is an executive of the CSACI, executive of the Canadian Paediatric Society, and member of the Healthcare Advisory Board for Food Allergy Canada. Vicki Cook has been a member of advisory boards for Sanofi Genzyme, Bausch Health and ALK, has received honoraria from Aralez Pharmaceuticals, ALK, Pfizer, and CSL Behring, and has a leadership role with CSACI.References
- 1. González-Cervera J, Arias Á, Redondo-González O, et al. Association between atopic manifestations and eosinophilic esophagitis: A systematic review and meta-analysis. Ann Allergy Asthma Immunol. 2017;118(5):582-590.e2.
- 2. Barbosa AC, Castro FM, Meireles PR, et al. Eosinophilic Esophagitis: Latent Disease in Patients with Anaphylactic Reaction to Cow's Milk. J Allergy Clin Immunol Pract. 2018;6(2):451-456.e1.
- 3. Lucendo AJ. Eosinophilic esophagitis: current evidence-based diagnosis and treatment in children and adults. Minerva Gastroenterol Dietol. 2018;64(1):62-74.
- 4. Soller L, Abrams EM, Carr S, et al. First Real-World Safety Analysis of Preschool Peanut Oral Immunotherapy. J Allergy Clin Immunol Pract. 2019;7(8):2759-2767.e5.
- 5. Chua GT, Chan ES, Invik R, et al. How We Manage Gastrointestinal Symptoms During Oral Immunotherapy Through a Shared Decision-Making Process-A Practical Guide for the Community Practitioner. J Allergy Clin Immunol Pract. 2023;11(4):1049-1055.
- Page navigation anchor for RE: oral immunotherapy in infantsRE: oral immunotherapy in infants
Are the authors going to monitor the children who are desensitized for eosinophilic esophagitis in the future?
Anecdotally, I have seen patients who outgrew their allergies I’m my longitudinal family practice later progress to this condition. It’s still a lesser evil than a severe allergic reaction of course, but it may be something that occurs. I have no hard data to substantiate this only a few possible cases in my family practice.Competing Interests: None declared.References
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