Strong Association of Eosinophilic Esophagitis and Oral Allergy Syndrome: Evidence Suggestive of Oral Route of Sensitization to Common Food-Pollen Allergens

Abstract

Introduction: Eosinophilic esophagitis (EoE) is a disease that is increasing in prevalence and has a significant negative affect on quality of life, affecting most commonly children and young adults. EoE is associated with food and aeroallergen sensitization and recent studies have shown a high prevalence of sensitization to common food-pollen allergens including profilins and PR-10. Oral allergy (OAS) or food-pollen syndrome is an IgE mediated reaction to common food-pollen allergens manifested by pruritus in oral cavity with ingestion of certain fresh fruits and vegetables. This condition is seen exclusively in allergic rhinitis patients sensitized to Tree, grass or Weed (T,G, or W). This is the first study evaluating the prevalence of OAS in a large cohort of EoE patients Methods: A retrospective chart review of EoE patients evaluated at Rush and Northwestern Allergy/Immunology clinics between (2007-2014). In addition 209 consecutive patients who presented with symptoms of rhinitis to Northwestern allergy clinic and tested positive to aeroallergens were used as control subjects. All cases were skin tested with a standard panel of aeroallergens and were questioned about symptoms of OAS. Results: Total of 185 EoE cases were enrolled in the study; 121 from Northwestern and 59 form Rush University. 93.5% percent of Patients with EoE had allergic rhinitis and 83.2% had evidence for sensitization to plant pollens T,G, or W. 53.5% of EoE cases had OAS which was significantly higher than allergic rhinitis patients (8.1%). A greater percentage of EoE patients who were sensitized to T, G or W had OAS (62.3%) as compared to the AR control group patients sensitized to T, G or W (10.2%). Conclusion: The high rate of sensitization to T, G and W in EoE patients and a high prevalence of foodpollen syndrome as compared to AR controls is suggestive that at least in a group of EoE cases the oral or esophageal mucosa might be the route of sensitization to these common food-pollen allergens. This is supported by recent studies showing a high rate of sensitization to profilins and PR-10 in EoE patients. An impaired barrier function in EoE patients could cause increased susceptibility to sensitization to common food-pollen or food allergens.