Important new research that may help identify the foods that cause eosinophilic esophagitis (EoE) was recently published in the medical journal Allergy. The research study, co-funded by the 2020 Hope APFED/AAAAI Grant Award, is led by senior author David A. Hill, MD, PhD, an attending physician with Children’s Hospital of Philadelphia’s Division of Allergy and Immunology. Dr. Hill recently shared this summary of his research findings with APFED:
Eosinophilic esophagitis (EoE) is a chronic food allergy that affects the esophagus, the tube that connects the mouth to the stomach. The disease occurs when eosinophils, a type of white blood cell, accumulate in the esophagus causing pain and injury.
Specific foods cause EoE, but currently there are no tests to quickly and easily identify which foods are responsible for this disease in a particular individual. Instead, patients are treated with a combination of proton-pump inhibitors, elimination diets, and steroids with recurrent endoscopies to determine whether and how well treatment is working.
Given that the current management strategy often takes significant time to reduce symptoms, the Hill Lab at Children’s Hospital of Philadelphia sought to develop a simple test that could pinpoint foods that cause EoE early in the course of disease so that those foods could be eliminated. To do so, we used EoE milk allergy as a proxy, and looked for immune signatures that would identify EoE milk allergy when compared to healthy children. Our team found that patients with EoE milk allergy had elevated milk-dependent memory T helper cells, and that these cells produced more of a cytokine known as interleukin-4 that contributes to allergy. The elevation of these biomarkers occurred whether the patient had stopped consuming milk or was still actively consuming it.
This finding, if applied to a regularly used assay, could help determine not only what foods an individual should avoid, but also guide timing on reintroducing causal foods, since emerging evidence shows that some children can outgrow EoE after long periods of food avoidance. The test would involve a simple blood draw and could yield accurate results quickly.
Future studies will be aimed at validating this approach in a prospective trial, and determining whether similar assays could apply to other foods that cause EoE. We are very grateful to the American Partnership for Eosinophilic Disorders for their support of this work and other research in our laboratory aimed at developing tools for the diagnosis and treatment of EoE.