fluticasone and Food-Hypersensitivity

Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disease of the esophagus that affects an estimated 34.4/100 000 people in Europe and North America. EoE affects both children and adults, and causes dysphagia, food impaction of the esophagus, and esophageal strictures.. EoE is defined by symptoms of esophageal dysfunction, such as vomiting, dysphagia, or feeding difficulties, in a patient with an esophageal biopsy demonstrating at least 15 eosinophils per high-power field in the absence of other conditions associated with esophageal eosinophilia such as gastroesophageal reflux disease or achalasia. Genetic factors and environmental factors, such as exposure to antibiotics early in life, are associated with EoE. Current therapies include proton pump inhibitors; topical steroid preparations, such as fluticasone and budesonide; dietary therapy with amino acid formula or empirical food elimination; and endoscopic dilation. In a systematic review of observational studies that included 1051 patients with EoE, proton pump inhibitor therapy was associated with a histologic response, defined as less than 15 eosinophils per high-power field on endoscopic biopsy, in 41.7% of patients, while placebo was associated with a 13.3% response rate. In a systematic review of 8 randomized trials of 437 patients with EoE, topical corticosteroid treatment was associated with histologic remission in 64.9% of patients compared with 13.3% for placebo. Patients with esophageal narrowing may require dilation. Objective assessment of therapeutic response typically requires endoscopy with biopsy.. EoE has a prevalence of approximately 34.4/100 000 worldwide. Treatments consist of proton pump inhibitors, topical steroids, elemental diet, and empirical food elimination, with esophageal dilation reserved for patients with symptomatic esophageal narrowing.

Topics: Adrenal Cortex Hormones; Adult; Amino Acids; Budesonide; Capsules; Combined Modality Therapy; Deglutition Disorders; Dilatation; Eosinophilic Esophagitis; Eosinophils; Esophagoscopy; Esophagus; Fluticasone; Food Hypersensitivity; Gene-Environment Interaction; Humans; Proton Pump Inhibitors

Eosinophilic esophagitis is a clinicopathologic disease that can present with a constellation of upper gastrointestinal symptoms and endoscopic findings in conjunction with significant infiltration of the esophageal tissue with eosinophils. Clinical and histologic resolution of the disease can be seen with dietary restriction therapies and systemic and topical corticosteroids. Because most patients have an atopic background and the disease seems to have an underlying T-helper type 2 pathogenesis, allergists and gastroenterologists need to be familiar with the diagnosis and management of this disease. In this review, clinical characteristics, endoscopic and histologic findings, and available therapy options are discussed.

Topics: Age Factors; Androstadienes; Budesonide; Eosinophilic Esophagitis; Eosinophils; Esophagus; Fluticasone; Food; Food Hypersensitivity; Humans; Sex Factors

This study was performed in patients with allergic rhinitis/conjunctivitis to birch pollen to determine whether patients with additional hypersensitivity to nuts and apples differed from patients without such hypersensitivity; the determination was in terms of results of skin prick test (SPT), specific IgE antibodies (RAST), and symptoms during the pollen season. Forty-seven patients with birch pollen allergy were investigated by RAST against birch and hazel pollen and by SPT. They were treated in a randomized, double-blind, placebo-controlled study with fluticasone propionate aqueous nasal spray or placebo. The area of the SPTs was larger and the specific IgE values higher in patients with hypersensitivity to nuts and apples. These patients also had more symptoms during the pollen season. We conclude that hypersensitivity to nuts is an indication of a more severe allergy in patients with birch pollen allergic rhinitis.

Topics: Adolescent; Adult; Androstadienes; Anti-Inflammatory Agents; Female; Fluticasone; Food Hypersensitivity; Fruit; Humans; Hypersensitivity; Immunoglobulin E; Male; Middle Aged; Nuts; Pollen; Radioallergosorbent Test; Severity of Illness Index; Skin Tests; Trees

Eosinophilic esophagitis (EoE) is an increasingly diagnosed disease, especially in the western world. Although its pathogenesis remains poorly understood, there is strong evidence that the eosinophilic inflammation in EoE is primarily triggered by immune dysregulation secondary to allergic sensitization to dietary or aero-allergens. Recent studies have reported a higher prevalence of EoE in children with congenital gastrointestinal malformations, i.e. esophageal atresia and/or tracheoesophageal fistula.. We present the case history of a 2-year-old boy who developed EoE in the aftermath of congenital diaphragmatic hernia (CDH) repair.. To the best of our knowledge, the following case report describes for the first time the possible association between CDH and EoE. Given the increasing reported prevalence of EoE in children with congenital gastrointestinal malformations, EoE should be rule out also in CDH survivors.

Topics: Anti-Inflammatory Agents; Biopsy; Diagnosis, Differential; Eosinophilic Esophagitis; Fluticasone; Food Hypersensitivity; Hernias, Diaphragmatic, Congenital; Humans; Infant; Male; Skin Tests

To our knowledge, in Asia, data on utility of allergy tests in management of eosinophilic esophagitis are lacking. The objective of our study was to determine the role of allergy evaluation in management of Saudi children with eosinophilic esophagitis.. Children diagnosed as having eosinophilic esophagitis during the period from 2009 to 2012 were referred to an allergist for allergy evaluation. The allergy evaluation consisted of total IgE level, radio-allergosorbent assay, and skin prick test. Depending on the results of the allergy tests, a restricted or elemental diet was established. Swallowed fluticasone inhaler was prescribed to patients who rejected or failed to respond to the diet. Clinical, endoscopic, and histological evaluation was performed in 8 weeks to assess response.. Eighteen children with eosinophilic esophagitis were included (13 males; mean age 5 years, range 1-11). Sensitization to foods was demonstrated in 14 patients: 4 with a positive test for a single food (28.5%), 1 for 2 food allergens (7%), and 9 for ≥3 food allergens (64.5%). The most common food allergens were milk, soybean, wheat, egg, and nuts. Three young children out of the total 14 patients responded to elemental formula. Four of the 10 older children on the allergy testing guided-dietary restriction achieved partial remission and the remaining 6 did not respond. All 10 patients responded to a swallowed fluticasone inhaler.. Although food sensitizations in Saudi children with eosinophilic esophagitis are common, the allergy tests had limited predictive value for the response to dietary elimination.

Topics: Androstadienes; Anti-Allergic Agents; Child; Child, Preschool; Eosinophilic Esophagitis; Female; Fluticasone; Follow-Up Studies; Food Hypersensitivity; Food, Formulated; Humans; Hypersensitivity; Immunoglobulin E; Infant; Male; Predictive Value of Tests; Radioallergosorbent Test; Retrospective Studies; Skin Tests

Topics: Adult; Androstadienes; Anti-Inflammatory Agents; Deglutition Disorders; Eosinophilic Esophagitis; Esophagoscopy; Fluticasone; Food Hypersensitivity; Humans; Male; Proton Pump Inhibitors

Symptoms of vomiting and dysphagia in children with eosinophilic esophagitis may be related to the development of mucosal fibrosis.. Our aims were to (1) investigate esophageal fibrosis in children with EoE compared to patients with gastroesophageal reflux disease and normal individuals, and (2) to assess the degree of mucosal fibrosis in patients with EoE before and after medical treatment.. A retrospective analysis of esophageal biopsies from patients with EoE, GERD, and normal mucosa was performed. Demographic data, clinical information, eosinophil number, and sub-epithelial fibrosis was compared among the groups. A similar comparison was performed in EoE patients, before and after therapy.. Esophageal biopsies from 53 children were included, of which 17 with EoE, 17 GERD, and 19 were normal. A significantly higher number of eosinophils and greater fibrosis was found in EoE patients vs. GERD and normal (fibrosis grade 2: 13 patients in the EoE group vs. one patient for each control group; p=0.0001). After therapy, a significant decrease in fibrosis and eosinophils number was noted in EoE patients [fibrosis grade 2: 10 (71.5%) patients vs. one (7.1%) patient, and eosinophil count was 35.5/HPF vs. 13.4/HPF, pre- and post-therapy, respectively; p<0.05]. The decrease in esophageal fibrosis paralleled the improvement in the related clinical symptoms.. A higher degree of esophageal fibrosis was found in patients with EoE compared to GERD or normal esophagus. Conventional therapy in EoE improved obstructive symptoms, decreased eosinophils count, and reversed the degree of fibrosis. We suggest that appropriate therapy in patients with EoE will improve clinical symptoms and histology.

Topics: Adolescent; Allergens; Androstadienes; Anti-Inflammatory Agents; Biopsy; Case-Control Studies; Child; Child, Preschool; Eosinophilic Esophagitis; Eosinophils; Esophagus; Female; Fibrosis; Fluticasone; Food Hypersensitivity; Gastroesophageal Reflux; Humans; Infant; Male; Mucous Membrane; Retrospective Studies; Treatment Outcome

Omalizumab is an anti-IgE monoclonal antibody available since 2006 for the treatment of GINA step 4 asthma. We studied a 41-year old male who has been suffering from severe steroid-resistant asthma with severe co-morbidity and treated with Omalizumab. He was found to be non-responder to the treatment until the 48th week, starting from which we began to see a distinct improvement in the symptoms and all the correlated parameters, in addition to remission of the co-existent allergy to milk.. we wish to point out the late response to Omalizumab, which occurred way beyond the times envisaged in literature. It seems possible that some patients are late responders to the drug.

Topics: Adult; Albuterol; Allergens; Androstadienes; Animals; Anti-Asthmatic Agents; Antibodies, Anti-Idiotypic; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Asthma; Bronchodilator Agents; Disease-Free Survival; Drug Resistance; Drug Therapy, Combination; Fluticasone; Food Hypersensitivity; Humans; Male; Milk; Omalizumab; Salmeterol Xinafoate; Spirometry; Time Factors

Topics: Adrenergic beta-Agonists; Albuterol; Amantadine; Analgesics, Non-Narcotic; Androstadienes; Aromatase Inhibitors; Asthma; Bronchodilator Agents; Donepezil; Drug Therapy, Combination; Female; Fluticasone; Food Hypersensitivity; Humans; Indans; Interferons; Latex Hypersensitivity; Letrozole; Mandelic Acids; Middle Aged; Multiple Sclerosis; Nebulizers and Vaporizers; Nitriles; Nootropic Agents; Parasympatholytics; Paresthesia; Piperidines; Respiratory Function Tests; Salmeterol Xinafoate; Thyroxine; Triazoles

Topics: Administration, Oral; Administration, Topical; Adult; Androstadienes; Anti-Allergic Agents; Dermatitis, Atopic; Drug Therapy, Combination; Fluticasone; Food Hypersensitivity; Humans; Hypersensitivity, Immediate; Male; Shiitake Mushrooms; Terfenadine

Eosinophilic oesophagitis is an emerging disease, well known also in paediatric age, probably caused by both IgE and non-IgE mediated food allergies, diagnosed by upper endoscopy with biopsy. The most severe complication is oesophageal stenosis. The identification of the offending allergens is often difficult; therapy is focused to eliminate the supposed antigenic stimulus, to control the acute symptoms and to induce long-term remission.. We report the clinical outcome and the typical endoscopic findings of children and adolescents affected by eosinophilic oesophagitis, referring a proposal of diagnostic and treatment protocol.. Twelve patients, affected by eosinophilic oesophagitis with a histological diagnosis, underwent radiographic upper gastro-intestinal series, 24 h pH-probe and standardised allergic testing; they were treated with steroids (oral prednisone and swallowed aerosolised fluticasone) and elimination diet. Dilations were performed when eosinophilic oesophagitis was not yet diagnosed, or in patients resistant to conventional treatment.. Two patients were lost to follow up (mean follow up: 1 year 11 months); seven patients have no symptoms and normal histology, five of them on restricted diet (without cow's milk protein) and two patients on elemental diet (amino acid formula). In two patients (no allergens identified), mild dysphagia and eosinophilic infiltration persist; one patients underwent Nissen fundoplication for Barrett's oesophagus: he has no symptoms and normal oesophagus, on restricted diet (without cow's milk/eggs protein and wheat).. The recognition of typical endoscopic picture with careful biopsies extended to the whole oesophagus, even in emergency, could more quickly lead to the correct diagnosis and avoid severe complications of eosinophilic oesophagitis in children, as stricture and failure to growth. Elimination diet is the key of resolution when the allergens are identified. A great challenge remains the relation between gastro-oesophageal reflux disease and eosinophilic oesophagitis, which should however be explained.

Topics: Administration, Inhalation; Administration, Oral; Adolescent; Aerosols; Androstadienes; Anti-Inflammatory Agents; Biopsy; Catheterization; Child; Child, Preschool; Endoscopy, Digestive System; Eosinophilia; Esophageal pH Monitoring; Esophagitis; Female; Fluticasone; Food Hypersensitivity; Humans; Immunoglobulin E; Infant; Male; Prednisone; Prospective Studies; Retrospective Studies; Skin Tests; Upper Gastrointestinal Tract

Eosinophilic esophagitis (EE) is a clinical-pathological disorder which is being increasingly diagnosed. It is etiologically associated with hypersensitivity to airborne allergens and/or dietary components. However, immediate hypersensitivity to foods has rarely been proven as the etiologic cause of the disorder. Two patients are presented with a history of rhinoconjunctivitis, allergic asthma, atopic dermatitis and food allergies which are currently under control and who show specific IgE to pulses and chicken respectively. These patients developed acute dysphagia and vomiting immediately after ingesting these foods and following appropriate examination were diagnosed as suffering from EE. The study also showed signs of blood hypereosinophilia while the esophageal manometry revealed a motor disorder characterized by aperistalsis and non-propulsive simultaneous waves affecting the lower two-thirds of the organ composed of smooth muscle. Topical treatment with fluticasone propionate was administered over a period of 3 months, in addition to a diet abstaining from the aforementioned foods and this led to remission of dysphagia and normalization of the endoscopic, histological and manometric studies of the esophagus. This situation remained stable for a considerable length of time after steroid treatment was discontinued, which showed that exposure to foods seemed to be the cause of the esophageal disorder. Similarly, allergies to inhalants and other digestive symptoms which appear upon immediate ingestion of the foods involved would not justify the sudden onset of dysphagia. We offer a pathophysiological explanation for the mechanisms of the disease based on the activation of eosinophils and mast cells by IgE and their ability to disturb the dynamic behavior of the neural and muscle components of the esophageal wall.

Topics: Adolescent; Androstadienes; Animals; Anti-Allergic Agents; Chickens; Deglutition Disorders; Eosinophilia; Esophagitis; Fabaceae; Female; Fluticasone; Food Hypersensitivity; Humans; Immunoglobulin E; Male