The current issue of Annals of Allergy, Asthma & Immunology focuses on eosinophilic esophagitis (EoE). Three different reviews highlight important aspects in the diagnosis, treatment and natural history of EoE.
Drs. Andrew Dickinson, Evan Dellon and Seema Aceves review the future of EoE and the role of the allergist in treatment. Potential novel molecules as targets for treatment are reviewed, as are diagnostic difficulties and possible ways to monitor patients via noninvasive methods, including the esophageal string test. Drs. Corey Ketchem and Alexandra Strauss-Starling review the natural history of EoE, focusing on the transition of pediatric to adult EoE and what happens if disease is untreated. They discuss the risk and possible development of strictures from untreated disease. The third review by Dr. Joseph Bellanti focuses on allergy and inborn errors of immunity (IEI). Several IEIs have an increased risk for EoE – particularly a STAT-6 gain of function mutation.
The editorial by Drs. Colby Sharlin, Alfred Doyle and Benjamin Wright highlight the important topic of oral immunotherapy (OIT) induced EoE. They discuss whether the prevalence is over- or underestimated due to diagnostic issues. As they point out, the risk factors for induction of OIT-EoE are unknown, and this is an important topic for future research.
This issue of Annals has other important findings for the practicing allergist-immunologist with three original articles on food allergy. Dr. Jessica Palmieri and colleagues examine the use of epitope testing for peanut allergy. In their real-world study, they demonstrate a 96% accuracy of epitope testing, suggesting a novel way to improve the diagnosis of peanut allergy without food challenges, although additional work is needed to duplicate this important finding.
Dr. Amy Scurlock evaluated epicutaneous peanut immunotherapy and found no significant differences in safety and efficacy in patients with comorbid atopic conditions compared to patients without atopic dermatitis. Dr. Melike Ocak and colleagues explore their experience with tahini challenges for patients with sesame seed allergy. They compared skin testing with sesame extract or tahini, assessing IgE specificity as well as sensitivity using lip dose challenge prior to oral food challenge. Read the article to find out what works best.
In addition to food allergies, there are three articles on nasal allergies, with two of the articles focused on diagnostic techniques including a novel method for nasal provocation testing by Paula von der Lage and colleagues. Dr. Yilin Hou and colleagues provide a detailed proteomic analysis of nasal fluids to help with diagnosis of polyps and show an increase in MCP-4 as a biomarker for chronic rhinosinusitis with nasal polyps, something which may help with treatment in the future.
Finally, Dr. Mengyu Chen, et al, examined the effect of changes in air quality, including particulate matter, on T2 phenotypes and allergen sensitization. They found that lowering pollution is associated with an increase in T2 phenotypes and allergen sensitization. Future research is required to determine whether these results are epiphenomena and signs of the hygiene hypothesis or true causation.
As you read this issue of Annals, we hope you are staying cool and enjoying the summer. As always, if you have any comments, please consider sending correspondence to Annals (email us at annals@ACAAI.org). We are always excited to hear how Annals has helped you improve the lives of your patients!
