A CASE SERIES OF EOSINOPHILIC ESOPHAGITIS MANAGEMENT IN PEDIATRIC PATIENTS UNDERGOING FOOD ALLERGEN ORAL IMMUNOTHERAPY

Abstract

<h3>Introduction</h3> Oral immunotherapy (OIT) is a promising treatment for food allergy and can significantly improve patients' quality of life. Eosinophilic esophagitis (EoE) is a known complication of OIT and is presently a contraindication for initiating OIT. We present the management and outcomes of a series of patients with EoE and concurrent treatment with OIT. <h3>Methods</h3> An IRB-approved retrospective chart review was conducted of pediatric patients within the multidisciplinary EoE clinic at our institution (from January 2004 to May 2022). Patients with a diagnosis biopsy-proven EoE and food allergy undergoing OIT were included in the analysis to create the largest case series of its type. <h3>Results</h3> Eleven patients aged 7-17 who were treated with OIT and underwent at least 2 esophagogastroduodenoscopies (EGD) were reviewed. Three patients were diagnosed with EoE prior to initiation of OIT, and the other 8 developed EoE after initiation of OIT. OIT was discontinued in 7 of 11 patients for management of EoE, in addition to treatment with proton pump inhibitors, topical corticosteroid, and/or food elimination diets. Four patients were able to continue OIT with improvement of symptoms and resolution noted on EGD. <h3>Conclusion</h3> The treatment of EoE in patients undergoing OIT requires shared decision-making with the patient/family, active OIT management, and close monitoring of treatment response involving allergists and gastroenterologists. The development of EoE does not always necessitate OIT discontinuation. This case series shows that with close monitoring and follow-up, a subset of patients with EoE can continue OIT safely and successfully.