D1.166 - The link between Food Allergy and Eosinophilic Esophagitis

Eosinophilic Esophagitis (EoE) is a chronic inflammatory disease characterized by severe and localized eosinophilic infiltration of the esophagus, leading to functional dysfunction. Even if a link between EoE and food allergy (FA) has been reported, the precise role of food allergens in the development of EoE has not yet been clarified. The aim of our study was to evaluate food allergy in EoE patients and to characterize their allergen sensitization profiles.

Twenty-four patients with EoE were recruited in the Allergy Unit and their demographic and clinical data collected. All patients underwent allergy work-up, including skin prick tests to food allergens, and detection of circulating IgE specific to native and cross-reactive food allergens (ImmunoCAP system, Phadia AB, Uppsala, Sweden). The severity of the hypersensitivity reaction (HR) to food allergens was classified according to the World Allergy Organization (WAO).

Among the EoE patients evaluated (13 male and 11 female; mean age of 35.3 years) 54% received a diagnosis of FA while 25% resulted only sensitized to at least one food allergen. According to the WAO classification, 42% of patients experienced a non anaphylactic reaction (grade 1-2) while 58% a anaphylactic one (grade 3-4). No patients experienced a severe reaction (grade 5). The most frequent food culprit allergens identified were legumes (62%) and fruits of the latex-fruit syndrome (62%), followed by Rosaceae fruits (54%) and nuts (46%). Among legumes, peanut sensitization was observed in 30.4% of patients and soybeans in 4.3%. By using Component Resolved Diagnosis (CRD), the most frequent sensitization profile was directed to Lipid Transfer Proteins (LTPs): Pru p3 (31.5%), Ara h9 (21%) and Cor a8 (10.5%), followed by PR-10 family: Pru p1 (10.5%), Ara h8 (5.3%) and Cor a1 (5.3%). 

More than 50% of the EoE patients evaluated resulted allergic to at least one food allergen with a predominant sensitization profile to LTP. According to the severity of the reactions, most of them were classified as non anaphylactic and none of them reach a grade 5. Therefore, an allergy work-up could improve the management of EoE patients.