Eosinophilic Esophagitis: Is It All Allergies?

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Presentation transcript:

Eosinophilic Esophagitis: Is It All Allergies? Jason M. Swoger, MD, MPH, Catherine R. Weiler, MD, PhD, Amindra S. Arora, MBBChir Mayo Clinic Proceedings Volume 82, Issue 12, Pages 1541-1549 (December 2007) DOI: 10.1016/S0025-6196(11)61101-4 Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 1 Basic pathway of eosinophilic activation and degranulation. In a sensitized individual, allergens react with IgE, causing mast cells to migrate to the esophagus. Mast cell degranulation occurs, causing release of eosinophil chemotactic factors, which induce eosinophil migration and degranulation. Eosinophilic granules release a variety of chemokines, cytokines, and cytotoxic proteins, which ultimately cause inflammation and tissue damage. In addition, the toxic granule proteins cause further mast cell degranulation, which perpetuates the cycle. APC = antigen-presenting cell; ECP = eosinophil cationic protein; EDN = eosinophil-derived neurotoxin; EPO = eosinophil peroxidase; IL = interleukin; MBP = major basic protein Mayo Clinic Proceedings 2007 82, 1541-1549DOI: (10.1016/S0025-6196(11)61101-4) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 2 Possible diagnostic and treatment algorithm for dietary intervention alone in adults with eosinophilic esophagitis (EE). EGD = esophagogastroduodenoscopy; Eos = eosinophils; HPF = high-power field. Adapted from Ann Allergy Asthma Immunol,24 with permission. Mayo Clinic Proceedings 2007 82, 1541-1549DOI: (10.1016/S0025-6196(11)61101-4) Copyright © 2007 Mayo Foundation for Medical Education and Research Terms and Conditions