This blog post is a research roundup of recent publications on eosinophilic diseases, including summaries, links, and citations for the following articles:

Immune System Reaction to Milk Proteins in Eosinophilic Esophagitis

A multi-institutional study led by researcher David A. Hill, MD, PhD, of Children’s Hospital of Philadelphia (CHOP), identified one of the allergens responsible for eosinophilic esophagitis (EoE) at a molecular level. The preliminary findings, published as a Correspondence Letter to The Journal of Allergy and Clinical Immunology, mark the first time researchers describe molecular details of how the immune system is recognizing food antigens in EoE. Based on this understanding of the milk allergen, the method could be replicated to identify other allergens that result in EoE. This work was supported by APFED donors through our HOPE Pilot Grant Award.

Julianna Dilollo, Alex Hu, Huiqi Qu, Karina E Canziani, Rachel L Clement, Sam J McCright, Wayne G Shreffler, Hakon Hakonarson, Jonathan M Spergel, Karen Cerosaletti, David A Hill. “A molecular basis for milk allergen immune recognition in eosinophilic esophagitis.” The Journal of Allergy and Clinical Immunology. Online January 31, 2025. DOI: 10.1016/j.jaci.2025.01.008.

Six-Month Asthma Control Score on Mepolizumab Predicts Remission in Eosinophilic Asthma

According to data published in The Journal of Allergy and Clinical Immunology: In Practice, among those with severe eosinophilic asthma who are treated with mepolizumab, a patient’s asthma control score at six-months while on this treatment is considered the “best predictor” of whether they will achieve remission in the 12 months that follow. “These results can be used to design a treat-to-target paradigm for asthma, in which treatment response is assessed at 6 months to predict clinical remission,” the study authors concluded.  View the abstract and visual summary.

Yuto Hamada, Peter G Gibso, Erin S Harvey, Sean Stevens, Hayley Lewthwaite, Michael Fricker, Vanessa M McDonald, Andrew Gillman, Mark Hew, Vicky Kritikos, John W Upham, Dennis Thomas. Early Treatment Response to Mepolizumab Predicts Clinical Remission in Severe Eosinophilic Asthma. The Journal of Allergy and Clinical Immunology: In Practice, Volume 13, Issue 2, 333 - 342.e9

Exploring the Underlying Causes of Symptom Severity in Eosinophilic Esophagitis

The Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR) investigated the underlying causes of symptom severity in eosinophilic esophagitis (EoE) by analyzing gene expression in the esophagus. Findings suggest that the severity of symptoms in EoE may be related to changes in certain cells deep within the esophagus, not just the surface layer. This means that cells beneath the lining of the esophagus might play an important role in how EoE develops and how severe a person’s EoE symptoms become.

• View the abstract and figures from the article published in The Journal of Allergy and Clinical Immunology: In Practice.
• Read a blog post summarizing the study in the Rare Research Report by the Rare Diseases Clinical Research Network (RDCRN).
• Listen to an audio version of the summary.

Seung Kim, MD, MSa ∙ Netali Ben-Baruch Morgenstern, PhDa ∙ Kasumi Osonoi, MDa ∙ Seema S. Aceves, MD, PhDb ∙ Nicoleta C. Arva, MD, PhDc ∙ Mirna Chehade, MD, MPHd ∙ Margaret H. Collins, MDe ∙ Evan S. Dellon, MD, MPHf ∙ Gary W. Falk, MD, MSg ∙ Glenn T. Furuta, MDh ∙ Nirmala P. Gonsalves, MDi ∙ Sandeep K. Gupta, MDj ∙ Ikuo Hirano, MDi ∙ Girish Hiremath, MD, MPHk ∙ David A. Katzka, MDl ∙ Paneez Khoury, MD, MHSm ∙ John Leung, MDn ∙ Robbie Pesek, MDo ∙ Kathryn A. Peterson, MD, MScip ∙ Maria A. Pletneva, MD, PhDq ∙ Jonathan M. Spergel, MD, PhDr ∙ Joshua B. Wechsler, MD, MSs ∙ Guang-Yu Yang, MD, PhDt ∙ Marc E. Rothenberg, MD, PhDa ∙ Tetsuo Shoda, MD, PhD. Nonepithelial Gene Expression Correlates With Symptom Severity in Adults With Eosinophilic Esophagitis. The Journal of Allergy and Clinical Immunology: In Practice, Volume 12, Issue 12, 3346 - 3355.e1. how the immune system is recognizing food antigens

This blog post is a research roundup of recent publications on eosinophilic diseases, including summaries, links, and citations for the following articles:

Longer-Term Biologic Use to Treat Severe Asthma/Eosinophilic Asthma

Doctors studied how well biologics work for people with severe asthma. They looked at 611 patients who used these medicines for at least a year. Almost half of the patients (46%) had their asthma get much better at some point during the study. This means they didn’t have any bad asthma attacks, didn’t need strong steroid medicines, and felt their breathing was under control. The longer patients used the biologics, the more likely they were to feel better. After 4 years of treatment, about 1 in 3 patients had their asthma well controlled.

On-treatment clinical remission of severe asthma with real-world longer-term biologic use. Chipps, Bradley E. et al. Journal of Allergy and Clinical Immunology: Global, Volume 4, Issue 1, 100365

Does Esophageal Dilation Impact Efficacy of Budesonide to Treat EoE?
Researchers studied how well budesonide oral suspension (BOS) works for people with EoE. Some patients with EoE have had esophageal dilation (stretching their esophagus to improve swallowing). The study looked at how BOS worked for those who had a previous esophageal dilation compared to those who have not had a dilation. They found that BOS helped reduce inflammation in the esophagus for both groups. However, people who had their esophagus stretched before didn’t feel as much improvement in swallowing as those who never had it stretched. This study helps doctors understand that a patient’s history of esophagus stretching might affect how they respond to this new medicine for EoE.

Hirano, Ikuo MD (posthumous)1; Collins, Margaret H. MD2; Katzka, David A. MD, FACG3; Mukkada, Vincent A. MD4; Falk, Gary W. MD, MS5; Terreri, Brian PharmD, MBA6; Boules, Mena MD6; Zhang, Wenwen PhD7; Desai, Nirav K. MD7; Dellon, Evan S. MD, MPH, FACG8. Effect of Esophageal Dilation History on Efficacy Outcomes in Patients With Eosinophilic Esophagitis Receiving Budesonide Oral Suspension. The American Journal of Gastroenterology ():10.14309/ajg.0000000000003197, November 12, 2024. | DOI: 10.14309/ajg.0000000000003197

Understanding Fibroblasts and Their Impact on the Esophagus
Researchers studied how EoE affects special cells called fibroblasts. These cells help heal and repair tissues. The study found that fibroblasts in people with EoE behave differently than normal. They tend to make the esophagus more rigid, similar to cartilage tissue. Instead of creating soft, flexible cells, these fibroblasts become more stiff and structured. They also move around more aggressively within the esophagus. Another key finding was that these cells have less of a specific protein on their surface, which disrupts their normal healing process. These changes make it harder for the esophagus to heal properly. The researchers discovered that adding a substance called adenosine could help fix some of these problematic cell behaviors. This study helps doctors understand why EoE causes long-term damage to the esophagus and suggests new ways to treat it.

Eosinophilic esophagitis drives tissue fibroblast regenerative programs toward pathologic dysfunction. Jumabay, Medet et al. Journal of Allergy and Clinical Immunology, Articles in Press

Men Face More Challenges with EoE: New Study Reveals Gender Differences

Researchers studied how eosinophilic esophagitis (EoE), a condition that causes inflammation in the esophagus, affects men and women differently. They looked at hospital records of nearly 22,000 patients with EoE from 2016 to 2020.The study found that men with EoE have more problems than women. Men were more likely to have their esophagus blocked, get food stuck, or have their esophagus tear. This was especially true for men aged 25-29. Women with EoE had fewer complications, but those aged 75-79 were more likely to have food get stuck. Interestingly, more black women had EoE compared to black men, but black men still had more complications. The researchers also noticed that men were most likely to have serious problems with their esophagus in March. This study helps doctors understand that EoE affects men and women differently, which could lead to better ways of treating patients based on their gender and age.

Patel H, Elmer J, Liaquat H. Exploring the impact of gender on the characteristics and complications of eosinophilic esophagitis. JGH Open. 2024;8(12):e70059. doi:10.1002/jgh3.70059

This blog post is a research roundup of recent publications on eosinophilic diseases, including summaries, links, and citations for the following articles:

Characteristics of Severe Asthma With Eosinophilic Granulomatosis With Polyangiitis

A study published in The Journal of Allergy and Clinical Immunology: In Practice suggests that EGPA is more common in people with severe asthma. It underscores for healthcare providers the importance of checking for additional symptoms in people who have high levels of eosinophils and working with other specialists to ensure proper care.

Youxin Puan, Kheng Yong Ong, Pei Yee Tiew, Gabriel Xu Wen Chen, Neville Wei Yang Teo, Andrea Hsiu Ling Low, Michael E. Wechsler, Mariko Siyue Koh. Characteristics of Severe Asthma Clinic Patients With Eosinophilic Granulomatosis With Polyangiitis, The Journal of Allergy and Clinical Immunology: In Practice, 2024, ISSN 2213-2198.

Game-changing Asthma Attack Treatment with Benralizumab

Benralizumab (Fasenra®) is a biologic treatment that made recent headlines after a study published in The Lancet Respiratory Medicine showed that giving patients an injection during an asthma flare-up was 30% more effective than the current standard treatment with steroid tablets, reducing the need for additional care. While benralizumab is already used in low doses as a long-term treatment for severe asthma, the trial demonstrated that a single higher dose at the time of a flare-up could provide powerful and immediate relief.

Ramakrishnan, Sanjay et al. Treating eosinophilic exacerbations of asthma and COPD with benralizumab (ABRA): a double-blind, double-dummy, active placebo-controlled randomised trial. The Lancet Respiratory Medicine, 2024.

Mepolizumab May Improve Underlying Airway Changes Associated with Asthma

A new study shows promising results for people with severe asthma using a treatment called mepolizumab (Nucala®). After a year of treatment, patients breathed better, had fewer asthma attacks, and showed signs of healing in their airways. The medicine not only helped with symptoms but also seemed to repair some of the damage asthma had caused to their lungs. This research suggests that mepolizumab could be a powerful tool for managing severe asthma and potentially improving the long-term health of patients’ airways.

Domvri K, Tsiouprou I, Bakakos P, Steiropoulos P, Katsoulis K, Kostikas K, Antoniou KM, Papaioannou AI, Rovina N, Katsaounou P, Papamitsou T, Pastelli N, Tryfon S, Fouka E, Papakosta D, Loukides S, Porpodis K. Effect of Mepolizumab in airway's remodelling in patients with late-onset severe asthma with an eosinophilic phenotype. The Journal of Allergy and Clinical Immunology. 2024 Nov 7:S0091-6749(24)01168-0. doi: 10.1016/j.jaci.2024.10.024. Epub ahead of print. PMID: 39521278.

Seasonal Patterns in Eosinophilic Esophagitis-Related Emergency Department Visits: A National Database Analysis

A study published in the American Journal of Gastroenterology looked at seasonal variations in EoE-related emergency department (ED) visits among adults. The authors report that among more than 18,000 EoE-related ED visits, they observed a significant seasonal variation that peaked in summer and lowering in winter. They also noted that the pattern was consistent across all U.S. regions, and that seasonal dietary habits and social behaviors likely contribute to EoE exacerbations.

Pan, Chun-Wei MD1,a; Dominguez, Alejandro Nieto MD1; Guifarro, Daniel MD1; Danpanichkul, Pojsakorn MD2; Pang, Maoyin MD, PhD3,a. Seasonal Patterns in Eosinophilic Esophagitis-Related Emergency Department Visits: A National Database Analysis. The American Journal of Gastroenterology ():10.14309/ajg.0000000000003226, November 26, 2024. | DOI: 10.14309/ajg.0000000000003226

Study Looks at Impact of Cannabis Use on Eosinophilic Esophagitis Treatment Outcomes

Researchers recently studied how cannabis use affects people with eosinophilic esophagitis (EoE) by examining 983 patients, of whom 80 reported cannabis use. Most cannabis users consumed the substance daily through inhalation.

They found that initially, cannabis users displayed milder esophageal inflammation, with fewer endoscopic signs of EoE. However, post-treatment analysis revealed these patients experienced greater inflammatory responses compared to non-users, despite similar symptom and histological improvements. This suggests that cannabis might make EoE harder to treat which could negatively affect EoE treatment outcomes.

Borinsky SA, Weir AA, LaFata SS, Gee TS, Thel HL, Cameron BA, Xue AZ, Kiran A, Ocampo AA, McCallen J, Lee CJ, Redd WD, Barlowe TS, Kaakati RN, Cotton CC, Eluri S, Reed CC, Dellon ES. Impact of cannabis use on presentation and treatment response in eosinophilic esophagitis. Diseases of the Esophagus. 2024 Oct 3:doae080. doi: 10.1093/dote/doae080. Epub ahead of print. PMID: 39363563.