Classification of patients with esophageal eosinophilia by patterns of sensitization revealed by a diagnostic assay for multiple allergen-specific IgEs

Abstract

Background

Eosinophilic esophagitis (EoE) is considered to be an immunoglobulin E (IgE)-mediated allergic disorder. Our goal was to examine IgE-mediated allergic sensitization patterns in patients with esophageal eosinophilia (EE).

Methods

We enrolled subjects with EE who underwent evaluation with a diagnostic panel to document multiple allergen-specific IgEs. Statistically significant groups were identified by cluster analysis. We also defined allergens based on their characteristics including outdoor, indoor, plant, and animal allergens.

Results

We classified patients with EE into 3 distinct groups, including cluster 1 (n = 62) who were minimally sensitized to most allergens except pollen and house dust, cluster 2 (n = 30) who were hypersensitized to outdoor and plant allergens, and cluster 3 (n = 15) who were hypersensitized to most allergens, most notably to indoor and animal allergens. Dysphagia reported among those in clusters 1, 2, and 3 at 35.5%, 46.7%, and 73.3%, respectively, (p = 0.028) and EoE endoscopic reference scores (EREFS) at 3.0, 6.0, and 8.0, respectively, (p < 0.001) differed significantly between the 3 clusters. Those in cluster 3 had a significantly higher prevalence of dysphagia (35.5% vs. 73.3%, p = 0.030), and higher EREFS with respect to rings (0.3 vs. 0.9, p = 0.003) and strictures (0.0 vs. 0.13, p = 0.011) compared to those in cluster 1.

Conclusions

IgE-mediated allergic sensitization patterns are associated with clinical features of patients with EE. Use of a diagnostic panel that detects multiple allergen-specific IgEs can help to explain the heterogeneous phenotype of this patient cohort.

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Abbreviations

BMI:

Body mass index

EE:

Esophageal eosinophilia

EoE:

Eosinophilic esophagitis

EPZ:

Esomeprazole

EREFS:

Eosinophilic esophagitis endoscopic reference score

HPF:

High-power field

IgE:

Immunoglobulin E

LPZ:

Lansoprazole

P-CAB:

Potassium-competitive acid blocker

PPI:

Proton pump inhibitor

RPZ:

Rabeprazole

Th2:

T helper type 2

TSLP:

Thymic stromal lymphopoietin

VPZ:

Vonoprazan

WBC:

Peripheral white blood cell count

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Correspondence to Fumio Tanaka.

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Nakata, A., Tanaka, F., Nadatani, Y. et al. Classification of patients with esophageal eosinophilia by patterns of sensitization revealed by a diagnostic assay for multiple allergen-specific IgEs. J Gastroenterol (2021). https://doi.org/10.1007/s00535-021-01766-3

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Keywords

  • Eosinophilic esophagitis
  • Immunoglobulin E
  • Allergens
  • Sensitization patterns
  • Diagnostic panel