Immunohistochemical markers for different eosinophilic esophagitis endotypes

• Grant number: 20/06929-5
• Support Opportunities: Regular Research Grants
• Start date: April 01, 2021
• End date: March 31, 2023
• Field of knowledge: Health Sciences - Medicine - Pathological Anatomy and Clinical Pathology
• Principal Investigator: Ariana Campos Yang
• Grantee: Ariana Campos Yang
• Host Institution: Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
• Associated researchers: ADRIANA MARCIA DA SILVA CUNHA BARBOSA ; Fabio Fernandes Morato Castro ; Keity Souza Santos ; Thais Mauad

Abstract

Currently, and globally, there has been a major "epidemic" in the diagnosis of food allergy and Eosinophilic Esophagitis (EoE). It is known that in general, the prevalence of EoE is around 0.4% in the general population, with reports of prevalence of up to 15% in patients with specific symptoms of alimentary dysphagia. In patients with IgE-mediated food allergy, this prevalence is around 4.7%. Until recently, it was believed that, in general, the diagnosis of EoE occurred after years of the presence of IgE-mediated food allergy, of incidental occurrence or even as a result of the treatment of oral immunotherapy with the allergenic food itself, in which patients with persistent clinical condition were submitted to. In our Allergy and Immunology outpatient clinic at Hospital das Clínicas, FM-USP, considered one of the largest national and Latin American reference centers for adult and pediatric patients diagnosed with food allergy and Eosinophilic Esophagitis, we developed a recent survey in which we conducted upper digestive endoscopy in all patients anaphylactic to cow's milk, regardless of the presence or absence of gastrointestinal symptoms and before undergoing any form of treatment. Thus, we diagnosed, in this group of patients, a very high prevalence of 38% of esophageal eosinophilia. Among these patients with esophageal eosinophilia, 47% had typical symptoms of EoE; 23.5% were oligosymptomatic - with symptoms that were difficult to detect unless an active search questionnaire was done; and we also found 29.5% of patients with an absent clinical history from the gastrointestinal point of view, and some even had already endoscopic changes suggestive of chronicity and esophageal remodeling. After this study, anaphylaxis to cows milk has already been considered a risk factor for EoE, and consequently more recent publications already suggest early interventions (such as pediatric upper digestive endoscopy) for diagnosis, even in asymptomatic patients. In addition to the fact that we hypothesized that EoE is an insidious and latent disease in this group of patients and that, perhaps it even precedes or coexists with severe and persistent food allergy, all this investigation raised doubts as to whether these anaphylactic patients to cow's milk represent a different endotype of Eosinophilic Esophagitis and have the same immunohistochemical markers as patients who present only EoE (without the concomitant diagnosis of anaphylaxis to cow s milk), which is the main objective of this research. (AU)