PURPOSE OF THE STUDY.
To assess and quantify the relationship between eosinophilic esophagitis (EoE) and oral immunotherapy (OIT) in patients with immunoglobulin E–mediated food allergy.
This meta-analysis included 15 studies in the final review. Overall, data from 711 patients (567 children and 144 not determined) were retrieved. The size of the study populations ranged from 1 to 247 cases.
A systematic literature search to identify articles dealing with EoE and immunotherapy was performed independently by 2 authors (AA, JMT) using Pubmed, Embase, and SCOPUS. Studies were included if they provided original data on the occurrence of EoE in patients undergoing OIT or sublingual immunotherapy. Studies evaluating the effectiveness of allergen immunotherapy in patients with previously demonstrated EoE were considered. Quality assessment of studies and data extraction was performed by the authors. Ninety-five percent confidence intervals were calculated for the incidence of EoE after OIT and for the efficacy of allergy immunotherapy on EoE remission. Heterogeneity was assessed by χ2, and quantified with I2 statistic. Publication bias was evaluated with a funnel plot.
The search yielded 118 reports. After review and exclusion, 15 studies were included in the review; 12 referred to OIT and were included in the meta-analysis calculations. Twelve studies reported on the appearance of EoE after OIT. The most common foods for OIT were milk, egg, and peanut. Approximately 2.7% of patients newly developed EoE after OIT (95% confidence interval 1.7%–4.0%, I2−= 0%). Differences were observed when analyzing reports published as full length articles versus abstracts (3.5% vs 2.5%). A significant publication bias was documented in the funnel plot analysis. The effectiveness of allergen immunotherapy in resolving EoE was documented in only 2 single case reports.
This analysis included an exhaustive search of the literature and found the development of EoE in up to 2.7% of patients with IgE mediated food allergy undergoing OIT. There was a lack of sufficient support to consider allergen immunotherapy-based treatments for patients with EoE. The putative development of EoE after OIT, triggered by the same offending food that caused an IgE mediated allergy, should also be taken into account as a potential side effect for OIT. This systematic review showed a significant publication bias, with few studies on the negative effect side.
Given the increasing prevalence of food allergies, new treatment modalities such as oral immunotherapy have been introduced. Clearly more research is required to determine whether EoE is a true and acceptable side effect and risk of oral immunotherapy.
- Copyright © 2015 by the American Academy of Pediatrics