Journal of Gastroenterology and Hepatology

Volume 39, Issue 4 pp. 701-707

Original Article - Gastroenterology (Clinical)

Allergic phenotype identified on allergen testing is associated with proton pump inhibitor nonresponse in eosinophilic esophagitis

Mayssan Muftah,

Mayssan Muftah

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA

Harvard Medical School, Boston, Massachusetts, USA

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

Mayssan Muftah and Davis A. Hartnett are co-first authors.Search for more papers by this author

Davis A. Hartnett,

Davis A. Hartnett

Harvard Medical School, Boston, Massachusetts, USA

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

Mayssan Muftah and Davis A. Hartnett are co-first authors.Search for more papers by this author

Ryan Flanagan,

Ryan Flanagan

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA

Harvard Medical School, Boston, Massachusetts, USA

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

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Walker D. Redd,

Walker D. Redd

Division of Gastroenterology and Hepatology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA

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Andrew Jenkins,

Andrew Jenkins

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA

Harvard Medical School, Boston, Massachusetts, USA

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

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Alison H. Goldin,

Alison H. Goldin

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA

Harvard Medical School, Boston, Massachusetts, USA

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

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Karen Hsu Blatman,

Karen Hsu Blatman

Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA

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Walter W. Chan,

Corresponding Author

Walter W. Chan

[email protected]

orcid.org/0000-0002-1709-8230

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA

Harvard Medical School, Boston, Massachusetts, USA

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

Correspondence

Walter W. Chan, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.

Email: [email protected]

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Mayssan Muftah,

Mayssan Muftah

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA

Harvard Medical School, Boston, Massachusetts, USA

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

Mayssan Muftah and Davis A. Hartnett are co-first authors.Search for more papers by this author

Davis A. Hartnett,

Davis A. Hartnett

Harvard Medical School, Boston, Massachusetts, USA

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

Mayssan Muftah and Davis A. Hartnett are co-first authors.Search for more papers by this author

Ryan Flanagan,

Ryan Flanagan

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA

Harvard Medical School, Boston, Massachusetts, USA

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

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Walker D. Redd,

Walker D. Redd

Division of Gastroenterology and Hepatology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA

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Andrew Jenkins,

Andrew Jenkins

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA

Harvard Medical School, Boston, Massachusetts, USA

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

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Alison H. Goldin,

Alison H. Goldin

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA

Harvard Medical School, Boston, Massachusetts, USA

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

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Karen Hsu Blatman,

Karen Hsu Blatman

Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA

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Walter W. Chan,

Corresponding Author

Walter W. Chan

[email protected]

orcid.org/0000-0002-1709-8230

Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA

Harvard Medical School, Boston, Massachusetts, USA

Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA

Correspondence

Walter W. Chan, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.

Email: [email protected]

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First published: 07 January 2024

https://doi.org/10.1111/jgh.16469

Citations: 2

Declaration of conflict of interest: WWC served on scientific advisory board for Phathom Pharmaceuticals, Sanofi Pharmaceuticals, and Regeneron Pharmaceuticals. No other relevant conflicts of interest for other authors. All authors approve of final submission.

Author contributions: MM and WWC initiated study concepts and design; all authors contributed to acquisition of data; MM and WWC performed analysis and interpretation of data; MM, DAH, and WWC drafted the manuscript; all authors contributed to critical revision of manuscript for important intellectual content; WWC provided administrative support and overall study supervision.

Financial support: Walker D. Redd is supported by NIH T32DK007634-34.

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Abstract

Background and Aim

Food/environmental allergens have been associated with eosinophilic esophagitis (EoE); however, the correlation between allergy profiles and disease responsiveness to proton pump inhibitor (PPI) therapy remains unclear. We aimed to assess the association between food/environmental allergies identified on allergen testing and histologic response to PPI in patients with treatment-naive EoE.

Methods

Adults with newly diagnosed EoE who underwent formal testing for food/environmental allergies at a tertiary center were included. All patients underwent twice-daily PPI for 8 weeks with subsequent repeat endoscopy and biopsy to assess histologic response. Patients with <15 eosinophils/hpf on post-PPI mucosal biopsies were classified as responders (PPI-r-EoE), while those with ≥15 eosinophils/hpf were nonresponders (PPI-nr-EoE).

Results

Sixty-one patients met inclusion criteria (21 PPI-r-EoE vs 40 PPI-nr-EoE). Demographic, clinical, and endoscopic finding variables were similar between groups. Positive food allergen test was more prevalent among PPI-nr-EoE patients (82.5% vs 42.9%, P = 0.003). On multivariable analysis, positive food allergen testing remained an independent predictor for PPI nonresponse (aOR 0.15, CI: 0.04–0.58, P = 0.0006). Positive environmental allergen testing was highly prevalent, with no significant differences between groups (77.5% vs 95.2%, P = 0.14). However, higher number of positive environmental allergens (23.3% [≥5 allergens] vs 73.3% [<5 allergens], P = 0.003) and specific aeroallergens correlated with PPI-nr-EoE.

Conclusion

Positive food allergy testing and increased environmental allergens predicted lower likelihood of histologic response to PPI in EoE. Our findings support an allergic phenotype of EoE that may less likely respond to PPI therapy. Formal allergen testing may play a role in therapy selection and tailored management in EoE.

Graphical Abstract

References

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Citing Literature

Volume39, Issue4

April 2024

Pages 701-707