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Bianchi A, Calvani M, Leonardi L, Remotti D, Paparella R. Is a strict cow's milk-free diet necessary to treat milk oral immunotherapy-related eosinophilic esophagitis? ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021033. [PMID: 34212930 PMCID: PMC8343733 DOI: 10.23750/abm.v92i3.10050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 02/06/2021] [Indexed: 11/23/2022]
Abstract
We report the case of a 15-year-old boy who developed eosinophilic esophagitis (EoE) during cow’s milk oral immunotherapy (CM-OIT). In order to not completely invalidate OIT benefits, baked milk-containing foods were allowed instead of a strict CM-free diet. However, histological remission of EoE was reached only after a strict cow’s milk-free diet, not associated to pharmacological treatment. Nevertheless, given the limited data on real incidence of food OIT related EoE and potential beneficial treatment for this condition, we highlight the need of prospective studies aimed to evaluate if a strict CM free diet in OIT related EoE is always necessary to obtain remission of the disease or similarly to CM EoE, baked milk-containing foods” diet could be abeneficial treatment also in these patients. (www.actabiomedica.it)
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Affiliation(s)
- Annamaria Bianchi
- a:1:{s:5:"en_US";s:41:"Azienda Ospedaliera San Camillo Forlanini";}.
| | - Mauro Calvani
- U.O.C. di Pediatria, Azienda Ospedaliera San Camillo Forlanini, Roma, Italia.
| | - Lucia Leonardi
- Dipartimento di Pediatria, Università Sapienza, Roma, Italia.
| | - Danilo Remotti
- U.O.C di Anatomia Patologica, Azienda Ospedaliera San Camillo Forlanini, Roma, Italia.
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Bogale K, Stern H, Jhaveri P, Jhaveri P. Needs Assessment for Eosinophilic Esophagitis Education in School Nurses. J Sch Nurs 2021; 38:478-485. [PMID: 33438514 DOI: 10.1177/1059840520986746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Over the past 2 decades, eosinophilic esophagitis (EoE) has become increasingly recognized as a common cause of gastrointestinal morbidity in children. A mainstay of treatment is food avoidance, which must be implemented in both the home and school settings for school-aged children. The aim of this study is to assess school nurses' familiarity with EoE with regard to food avoidance and treatment in the school setting. We conducted a 19-question online survey of 60 school nurses (elementary through high school) recruited from Dauphin, Lebanon, and Lancaster Counties in Pennsylvania. Results indicated that 62% of respondents were familiar with EoE. However, only 22% felt comfortable distinguishing between symptoms of EoE and food-dependent anaphylaxis. Almost all respondents (97%) were interested in learning more about EoE. We report significantly increased familiarity with food-dependent anaphylaxis in comparison with EoE among school nurses. There is an interest and need for increasing education on EoE.
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Affiliation(s)
- Kaleb Bogale
- Penn State College of Medicine, Penn State Health, Hershey, PA, USA
| | - Heather Stern
- Penn State College of Medicine, Penn State Health, Hershey, PA, USA.,Division of Allergy and Immunology, Department of Pediatrics, Penn State Children's Hospital, Penn State Health, Hershey, PA, USA
| | - Punit Jhaveri
- Penn State College of Medicine, Penn State Health, Hershey, PA, USA.,Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Penn State Children's Hospital, Penn State Health, Hershey, PA, USA
| | - Pooja Jhaveri
- Penn State College of Medicine, Penn State Health, Hershey, PA, USA.,Division of Allergy and Immunology, Department of Pediatrics, Penn State Children's Hospital, Penn State Health, Hershey, PA, USA
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3
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Brown-Whitehorn T, Spergel JM. Food allergy and eosinophilic gastrointestinal disorders. JOURNAL OF FOOD ALLERGY 2020; 2:39-43. [PMID: 39022152 PMCID: PMC11250641 DOI: 10.2500/jfa.2020.2.200010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Eosinophilic esophagitis (EoE) is a non-immunoglobulin E mediated disorder that has been seen with increasing frequency over the past 25 years. Although the presentation varies per age group from vomiting and refusal to eat in infants and toddlers to abdominal pain and dysphagia in school-aged children, and food impaction and indigestion in adolescents and adults. Treatment options include proton-pump inhibitors, dietary avoidance, swallowed steroids, or a combination of these. Newer therapies with biologics show promise in early studies. Cow's milk is the most common food trigger of EoE across all age groups, followed by wheat and eggs. Different dietary avoidance strategies have been used, and help from a knowledgeable nutritionist is often key to success. Patients with EoE commonly have other baseline atopic disease. Clinicians who take care of patients who are atopic, therefore, should have a higher index of suspicion for EoE in patients with dysphagia. The goals of treatment are both a decrease in symptoms and normalization of esophageal histology. Eosinophilic gastrointestinal diseases are less common and less likely to respond to dietary therapies and/or avoidance. Pathogenesis seems to be different and may be more autoimmune mediated. Trialing dietary restrictions is certainly an option in this cohort of patients. For persistent symptoms and abnormalities, systemic medications have been used, although biologics may be used in the future. Additional studies are needed to determine which patients will respond to which therapies.
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Affiliation(s)
- Terri Brown-Whitehorn
- From the Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan M Spergel
- From the Division of Allergy and Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
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Rustagi S, Mullins D, Yanney E. Current updates in diagnosis and management of eosinophilic esophagitis. Curr Probl Pediatr Adolesc Health Care 2020; 50:100783. [PMID: 32446911 DOI: 10.1016/j.cppeds.2020.100783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Indexed: 12/13/2022]
Abstract
Eosinophilic esophagitis is a relatively new, moderately-well understood disease. It is one of the leading causes of dysphagia in the pediatric population. Thought to be triggered by food ingestion, it is distinctly different from food allergies. Although endoscopy is required for diagnosis, this article will review warning signs and symptoms that aid with evaluation and diagnosis of this disease. Treatment modalities and management are evolving and more research is needed.
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Affiliation(s)
- Shelly Rustagi
- Department of Pediatric Gastroenterology, Dayton Children's Hospital, One Children's Plaza, Dayton, OH 45404, United States; Boonshoft School of Medicine, Wright State University, Dayton, OH, United States.
| | - Denise Mullins
- Department of Pediatric Gastroenterology, Dayton Children's Hospital, One Children's Plaza, Dayton, OH 45404, United States
| | - Erica Yanney
- Department of Pediatric Gastroenterology, Dayton Children's Hospital, One Children's Plaza, Dayton, OH 45404, United States
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Ruffner MA, Capucilli P, Hill DA, Spergel JM. Screening children for eosinophilic esophagitis: allergic and other risk factors. Expert Rev Clin Immunol 2019; 15:315-318. [PMID: 30722709 PMCID: PMC6687298 DOI: 10.1080/1744666x.2019.1579643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/04/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Melanie A Ruffner
- a Division of Allergy & Immunology , Children's Hospital of Philadelphia , Philadelphia , PA , USA
- b Department of Pediatrics , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
| | - Peter Capucilli
- a Division of Allergy & Immunology , Children's Hospital of Philadelphia , Philadelphia , PA , USA
| | - David A Hill
- a Division of Allergy & Immunology , Children's Hospital of Philadelphia , Philadelphia , PA , USA
- b Department of Pediatrics , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
| | - Jonathan M Spergel
- a Division of Allergy & Immunology , Children's Hospital of Philadelphia , Philadelphia , PA , USA
- b Department of Pediatrics , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
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Mehr S, Brown-Whitehorn T. What do allergists in practice need to know about non-IgE-mediated food allergies. Ann Allergy Asthma Immunol 2019; 122:589-597. [PMID: 30935977 DOI: 10.1016/j.anai.2019.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Sam Mehr
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Victoria, Australia; Department of Allergy and Immunology, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
| | - Terri Brown-Whitehorn
- Division of Allergy and Immunology, Department of Pediatric, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, The University of Pennsylvania, Philadelphia, Pennsylvania
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