PMID- 38185799 OWN - NLM STAT- MEDLINE DCOM- 20240404 LR - 20240405 IS - 1440-1746 (Electronic) IS - 0815-9319 (Print) IS - 0815-9319 (Linking) VI - 39 IP - 4 DP - 2024 Apr TI - Allergic phenotype identified on allergen testing is associated with proton pump inhibitor nonresponse in eosinophilic esophagitis. PG - 701-707 LID - 10.1111/jgh.16469 [doi] AB - 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. CI - (c) 2024 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd. FAU - Muftah, Mayssan AU - Muftah M AD - Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA. AD - Harvard Medical School, Boston, Massachusetts, USA. AD - Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. FAU - Hartnett, Davis A AU - Hartnett DA AD - Harvard Medical School, Boston, Massachusetts, USA. AD - Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. FAU - Flanagan, Ryan AU - Flanagan R AD - Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA. AD - Harvard Medical School, Boston, Massachusetts, USA. AD - Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. FAU - Redd, Walker D AU - Redd WD AD - Division of Gastroenterology and Hepatology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA. FAU - Jenkins, Andrew AU - Jenkins A AD - Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA. AD - Harvard Medical School, Boston, Massachusetts, USA. AD - Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. FAU - Goldin, Alison H AU - Goldin AH AD - Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA. AD - Harvard Medical School, Boston, Massachusetts, USA. AD - Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. FAU - Hsu Blatman, Karen AU - Hsu Blatman K AD - Section of Allergy and Clinical Immunology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA. FAU - Chan, Walter W AU - Chan WW AUID- ORCID: 0000-0002-1709-8230 AD - Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, USA. AD - Harvard Medical School, Boston, Massachusetts, USA. AD - Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. LA - eng GR - T32 DK007634/DK/NIDDK NIH HHS/United States GR - T32DK007634-34/GF/NIH HHS/United States PT - Journal Article DEP - 20240107 PL - Australia TA - J Gastroenterol Hepatol JT - Journal of gastroenterology and hepatology JID - 8607909 RN - 0 (Proton Pump Inhibitors) RN - 0 (Allergens) RN - Eosinophilic enteropathy SB - IM MH - Adult MH - Humans MH - *Eosinophilic Esophagitis/diagnosis/drug therapy/pathology MH - Proton Pump Inhibitors/adverse effects MH - Allergens/therapeutic use MH - Endoscopy, Gastrointestinal MH - *Enteritis MH - *Eosinophilia MH - *Gastritis PMC - PMC10990792 MID - NIHMS1953894 OTO - NOTNLM OT - Environmental allergy OT - Eosinophilic esophagitis OT - Food allergy OT - Proton pump inhibitor COIS- Potential Conflicts 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. EDAT- 2024/01/08 00:42 MHDA- 2024/04/04 06:45 PMCR- 2025/04/01 CRDT- 2024/01/07 23:44 PHST- 2023/11/12 00:00 [revised] PHST- 2023/09/05 00:00 [received] PHST- 2023/12/18 00:00 [accepted] PHST- 2025/04/01 00:00 [pmc-release] PHST- 2024/04/04 06:45 [medline] PHST- 2024/01/08 00:42 [pubmed] PHST- 2024/01/07 23:44 [entrez] AID - 10.1111/jgh.16469 [doi] PST - ppublish SO - J Gastroenterol Hepatol. 2024 Apr;39(4):701-707. doi: 10.1111/jgh.16469. Epub 2024 Jan 7.