The Relationship Between Eosinophilic Esophagitis and Immunotherapy

Immunol Allergy Clin North Am. 2024 May;44(2):281-291. doi: 10.1016/j.iac.2024.01.001. Epub 2024 Feb 14.

Abstract

Immunotherapy is a treatment approach based on the principle of incremental allergen exposure to achieve desensitization. Recently, oral immunotherapy has been introduced as a treatment of IgE-mediated food allergy. Some patients receiving oral immunotherapy for food allergy may develop eosinophilic esophagitis. Here, we summarize the literature examining this association, its treatment, and outcomes and discuss possible explanations for this clinical phenomenon. We further identify potential associations with aeroallergen sensitivity and other forms of immunotherapy including subcutaneous immunotherapy and sublingual immunotherapy. Finally, we discuss management of immunotherapy-induced eosinophilic esophagitis. Epicutaneous immunotherapy is highlighted as an area of therapeutic investigation.

Keywords: Adverse effects; Allergy shots; Eosinophil; Eosinophilic gastrointestinal disease; Oral immunotherapy.

Publication types

  • Review

MeSH terms

  • Allergens / therapeutic use
  • Desensitization, Immunologic / adverse effects
  • Eosinophilic Esophagitis* / etiology
  • Eosinophilic Esophagitis* / therapy
  • Food Hypersensitivity* / drug therapy
  • Humans
  • Sublingual Immunotherapy*

Substances

  • Allergens