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Clinical Reviews in Allergy & Immunology

, Volume 55, Issue 1, pp 56–64 | Cite as

Eosinophilic Esophagitis: an Important Comorbid Condition of Asthma?

  • Sandy R. Durrani
  • Vincent A. Mukkada
  • Theresa W. Guilbert
Article

Abstract

Eosinophilic esophagitis and asthma are frequently found as comorbid conditions in children and adults along with other manifestations of atopic diathesis. These two conditions have similar T helper 2 responses-driven pathophysiology and share common management strategies such as using systemic corticosteroids and targeted anti-cytokine biologic therapies. Review of the literature finds that asthma is often a comorbid condition in eosinophilic esophagitis in both children and adults; however, the EoE-asthma relationship remains poorly characterized mechanistically and clinically. EoE and asthma commonly share several comorbid conditions such as allergic rhinitis and gastroesophageal reflux disease; therefore, addressing these comorbid conditions has the potential to improve and/or maintain control in both diseases. Similar to asthma, patients with EoE frequently demonstrate elevations in serum markers of atopy, including serum IgE levels, peripheral eosinophil counts, and T helper 2-related cytokines. Gastroesophageal reflux disease is thought to affect asthma through microaspirations, airway hyperresponsiveness, and increased vagal tone. The understanding of the relationship between gastroesophageal reflux and EoE is still evolving but seems to be bidirectional and interactive. In terms of treatment, similar classes of medications have been used in both EoE and asthma. In both children and adults, EoE remission can be achieved by food trigger avoidance and use of corticosteroids and biologic therapies. Asthma control is mostly achieved through inhaled corticosteroids, and long but biologic therapies are increasingly used in severe subsets of the disease. Significant clinical and mechanistic work needs to be accomplished to better understand the relationship between asthma, EoE, and their interaction with other allergic diseases. Understanding whether shared mechanisms exist can lead to the development of new diagnostic and therapeutic strategies. The following review examines the existing literature regarding prevalence, common comorbidities, and potential therapeutic approach and identifies gaps in knowledge and future directions.

Keywords

Asthma Eosinophilic esophagitis Gastroesophageal reflux disease Prevalence Diagnosis Treatment 

Abbreviations

Ab

Antibody

CS

Corticosteroid

EoE

Eosinophilic esophagitis

EGF

Epidermal growth factor

FGF-2

Fibroblast growth factor 2

TSLP

Thymic stromal lymphopoietin

GERD

Gastroesophageal reflux disease

ICS

Inhaled corticosteroid

PPI

Proton pump inhibitor

PPI-REE

Proton pump inhibitor-responsive esophageal eosinophilia

SCS

Swallowed corticosteroid

TH2

T helper 2

Notes

Funding Support

This work (VM) was supported by the NIH Grant U54 AI117804. The Consortium for Eosinophilic Gastrointestinal Disease Researchers (CEGIR, U54 AI117804) is part of the Rare Diseases Clinical Research Network (RDCRN), an initiative of the Office of Rare Diseases Research (ORDR), NCATS, and is funded through collaboration between NIAID, NIDDK, and NCATS. CEGIR is also supported by patient advocacy groups including the American Partnership for Eosinophilic Disorders (APFED), Campaign Urging Research for Eosinophilic Diseases (CURED), and Eosinophilic Family Coalition (EFC).

Compliance with Ethical Standards

Dr. Durrani reports funding from Sanofi/Regeneron.

Dr. Mukkada reports funding from the NIH, PCORI, and Shire. He has done consulting work with hire.

Dr. Guilbert reports personal fees from the American Board of Pediatrics; Pediatric Pulmonary Subboard, personal fees from Teva, personal fees from GSK, personal fees from Regeneron Pharmaceuticals, grants from NIH, other from UpToDate, personal fees from Merck, grants and personal fees from Sanofi/Regeneron, personal fees from Novartis/Regeneron, personal fees from Aviragen, and personal fees from GSK/Regneron, outside the submitted work.

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Allergy and ImmunologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Division of Pulmonary MedicineCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  4. 4.Division of GastroenterologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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