Classification of patients with esophageal eosinophilia by patterns of sensitization revealed by a diagnostic assay for multiple allergen-specific IgEs

J Gastroenterol. 2021 May;56(5):422-433. doi: 10.1007/s00535-021-01766-3. Epub 2021 Feb 16.

Abstract

Background: Eosinophilic esophagitis (EoE) is considered to be an immunoglobulin E (IgE)-mediated allergic disorder. Our goal was to examine IgE-mediated allergic sensitization patterns in patients with esophageal eosinophilia (EE).

Methods: We enrolled subjects with EE who underwent evaluation with a diagnostic panel to document multiple allergen-specific IgEs. Statistically significant groups were identified by cluster analysis. We also defined allergens based on their characteristics including outdoor, indoor, plant, and animal allergens.

Results: We classified patients with EE into 3 distinct groups, including cluster 1 (n = 62) who were minimally sensitized to most allergens except pollen and house dust, cluster 2 (n = 30) who were hypersensitized to outdoor and plant allergens, and cluster 3 (n = 15) who were hypersensitized to most allergens, most notably to indoor and animal allergens. Dysphagia reported among those in clusters 1, 2, and 3 at 35.5%, 46.7%, and 73.3%, respectively, (p = 0.028) and EoE endoscopic reference scores (EREFS) at 3.0, 6.0, and 8.0, respectively, (p < 0.001) differed significantly between the 3 clusters. Those in cluster 3 had a significantly higher prevalence of dysphagia (35.5% vs. 73.3%, p = 0.030), and higher EREFS with respect to rings (0.3 vs. 0.9, p = 0.003) and strictures (0.0 vs. 0.13, p = 0.011) compared to those in cluster 1.

Conclusions: IgE-mediated allergic sensitization patterns are associated with clinical features of patients with EE. Use of a diagnostic panel that detects multiple allergen-specific IgEs can help to explain the heterogeneous phenotype of this patient cohort.

Keywords: Allergens; Diagnostic panel; Eosinophilic esophagitis; Immunoglobulin E; Sensitization patterns.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Eosinophilic Esophagitis / classification*
  • Eosinophilic Esophagitis / immunology*
  • Eosinophilic Esophagitis / physiopathology
  • Female
  • Humans
  • Immunization / methods
  • Immunization / statistics & numerical data
  • Japan
  • Male
  • Middle Aged
  • Retrospective Studies
  • Statistics, Nonparametric