Esophageal eosinophilia caused by milk proteins: From suspicion to evidence based on 2 case reports

• Published in: Journal of allergy and clinical immunology 2012-05, Vol.129 (5), p.1416-1419
• Main Authors: Terrados Cepeda, Soledad, MD, Antolin-Amerigo, Dario, MD, Foruny, Jose Ramóm, MD, Gonzalez, Ana Saiz, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Allergens - adverse effects; Allergies; Allergy and Immunology; Animals; Cattle; Deglutition Disorders - diagnosis; Deglutition Disorders - diet therapy; Deglutition Disorders - etiology; Diet Therapy; Dysphagia; Eosinophilia - diagnosis; Eosinophilia - diet therapy; Eosinophilia - etiology; Esophagus - immunology; Esophagus - metabolism; Esophagus - pathology; Female; Food; Food allergies; Gastroesophageal reflux; Humans; Immunoglobulin E - blood; Milk; Milk Hypersensitivity - complications; Milk Hypersensitivity - diagnosis; Milk Hypersensitivity - diet therapy; Milk Proteins - administration & dosage; Milk Proteins - adverse effects; Milk Proteins - immunology; Patients; Proteins; Sheep; Skin; Skin Tests
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2012.03.008

To the Editor: The First International Gastrointestinal Eosinophilic Research Symposium defined eosinophilic esophagitis (EoE) as a primary clinicopathologic disorder of the esophagus characterized by esophageal symptoms, upper gastrointestinal tract symptoms, or both in association with esophageal mucosal biopsy specimens containing more than 15 intraepithelial eosinophils/high-power field (hpf) in 1 or more biopsy specimens and absence of pathologic gastroesophageal reflux disease, as evidenced by a normal pH-monitoring study of the distal esophagus or lack of response to high-dose proton pump inhibitor medication.1,2 EoE mostly occurs in male subjects (80%) and appears to have a common familial form and a strong association with atopy (70%). [...]a diet based on skin test results showed a 69% reduction in symptoms.2,4 Comparing these findings with those of our series of children (n = 17), avoidance of culprit foods identified by means of skin tests or specific IgE measurements achieved complete remission in 9 of 17 patients. [...]3 patients achieved remission of symptoms with an elemental diet.