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Patients underwent a complete history,

physical exam, skin prick testing by

classical method, and an accelerated

immunotherapy program. Both patients

reached a maintenance dose of 0.5ml

of a 1:1 concentration. Eosinophilic

esophagitis was diagnosed via

esophagogastroduodenoscopy (EGD)

and biopsy.

Background Patient 1

Here we describe two unique cases

regarding the potential effects of allergy

immunotherapy on patients with

eosinophilic esophagitis (EE).

Methods

Patient 2 presented with complaints of

dysphagia and seasonal allergy

symptoms. Skin prick test revealed

positive results to trees, grass, weeds and

cockroach, and was negative to all foods.

Daily symptoms of dysphagia were

uncontrolled on a proton pump inhibitor

alone. The patient was referred to a GI

specialist for a definitive diagnosis, and

eosinophilic esophagitis was confirmed

with an EGD and biopsy. An elimination

diet was not initiated. Patient was

prescribed a daily swallowed viscous

budesonide and Splenda mixture for three

months after which treatment was

stopped with improvement in symptoms.

Three months after swallowed

budesonide was discontinued, allergy

immunotherapy was initiated for treatment

of allergic rhinitis. Immunotherapy was

continued for 1.5 years until discontinued

by the patient. Upon completion, the

patient reported that dysphagia had

continued to improve since starting

immunotherapy.

Patient 2 References

1. Akei, H.S., Mishra, A., Blanchard, C., &

Rothenberg, M.E. (2005).

Epicutaneous antigen exposure primes

for experimental eosinophilic

esophagitis in mice. Gastroenterology

129(3) 984-985.

2. Rayapudi, M., Mavi, P., , 129(3Zhu, X.,

Akhilesh, Pandey, A., Abonia, J.,

Rothenberg, M., & Mishra, A. (2010).

Indoor insect allergens are potent

inducers of experimental eosinophilic

esophagitis in mice. Journal of

Leukocyte Biology, 88(2), 337-346.

3. Onbasi, K., Sin, A.Z., Doganavsargil,

B., Onder, G.F., Bor, S., & Sebik, F.

(2005). Eosinophil infiltration of the

oesophageal mucosa in patients with

pollen allergy during the season.

Clinical & Experimental Allergy 35(11),

1423-1431.

Contacts

Please contact our office at 614-328-9927

with questions, or Valerie@ohallergy.com.

Patient 1 was previously diagnosed with

eosinophilic esophagitis and symptoms

were well controlled with an elimination

diet. Through the elimination diet the

patient was avoiding wheat, dairy, eggs,

seafood, peanuts, and tree nuts. Patient

presented for evaluation of seasonal

allergy symptoms and food allergies. Skin

prick test revealed positive results to dust

mites, cat, dog, grass, trees, weeds, milk,

egg, peanut, multiple tree nuts, and

sesame. Patient was started on

immunotherapy for allergic rhinitis, and

after six months of treatment the patient

reported that dysphagia had progressively

worsened despite avoidance of all known

food triggers.

The inhalation of aeroallergens may have

an effect on the inflammation occurring in

the esophagus of eosinophilic esophagitis

patients. It is hypothesized that using

immunotherapy to reduce sensitization

would greatly impact this inflammatory

response; however, there are no

controlled studies on allergy

immunotherapy as an adjunctive

treatment for eosinophilic esophagitis in

human subjects. Our case reports

indicate that there is uncertainty on

whether or not immunotherapy can impact

eosinophilic esophagitis, and whether this

impact would be harmful or beneficial.

Our recommendations are to continue

research on the role of aeroallergens in

the pathogenesis of eosinophilic

esophagitis, to consider the effects of

immunotherapy on eosinophilic

esophagitis, and to assess the risks and

benefits of continuing immunotherapy on

patients with eosinophilic esophagitis.

Conclusions

Valerie Miller, CNP; Erin Lanford, CNP; Julia Kurz, CNP; Summit Shah, MD; Gital Karamchandani-Patel, MD

Premier Allergy Dublin, Ohio

P155: The Potential Effects of Allergy Immunotherapy on Eosinophilic Esophagitis

Multiple esophageal rings present on an

EGD of a patient with EE.

Graphic 51432 Courtesy of UpToDate

Control study with mice

showing eosinophil

increase in the esophagus

following exposure to

indoor allergens. Courtesy

of Rayapudi et al., (2010)