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Oral Tolerance and Eosinophilic Esophagitis

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Eosinophilic Esophagitis

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

The role of food allergy in EoE may be explained by a breakdown in oral tolerance or a failure in the induction of tolerance. Oral tolerance is the physiologic mechanism by which immune responses to an antigen are suppressed by prior administration of the antigen by the oral route. This normal process is crucial in allowing a wide array of dietary proteins access to the body without activating harmful immune responses. Oral tolerance presumably evolved as an analog of self-tolerance to prevent potentially dangerous hypersensitivity reactions to harmless food proteins and commensal gut flora. The lumen of the gastrointestinal tract, the largest immunologic organ in the body, is continually exposed to numerous dietary proteins. Here, antigen-presenting cells encounter food proteins and subsequently activate regulatory T lymphocytes that reside in the loose connective tissue beneath the gastrointestinal epithelium. These cells then suppress cellular and humoral immune responses to the protein. In nonallergic hosts, the majority of food proteins are absorbed without provoking injurious local or systemic immune responses. The pathologic cellular and humoral immune responses that characterize food allergy likely result from either a failure in establishing tolerance or a breakdown in existing tolerance. It is possible that similar mechanisms underlie the pathogenesis of EoE.

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Allergy and Immunology, Duke University Medical Center, Durham, NC, USA

    Pooja Varshney MD (Fellow-in-Training)

  2. Department of Pediatrics, Division of Allergy and Immunology, Duke University Medical Center, 2644, Durham, NC, 27710, USA

    A. Wesley Burks MD

Authors
  1. Pooja Varshney MD
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  2. A. Wesley Burks MD
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Correspondence to A. Wesley Burks MD .

Editor information

Editors and Affiliations

  1. The Children’s Hospital of Philadelphia, Center for Pediatric Eosinophilic Disord, The Univeristy of Pennsylvania School of, 34th Street & Civic Center Blvd., Philadelphia, 19104, Pennsylvania, USA

    Chris A. Liacouras

  2. University Medical Center, Pediatric Gastroenterology and Nutrition, Greenville Hospital System, Patewood Drive 200, Greenville, 29615, South Carolina, USA

    Jonathan E. Markowitz

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Varshney, P., Burks, A.W. (2012). Oral Tolerance and Eosinophilic Esophagitis. In: Liacouras, C., Markowitz, J. (eds) Eosinophilic Esophagitis. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-60761-515-6_26

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  • DOI: https://doi.org/10.1007/978-1-60761-515-6_26

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  • Publisher Name: Humana Press

  • Print ISBN: 978-1-60761-514-9

  • Online ISBN: 978-1-60761-515-6

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