Eosinophilic esophagitis: A potential complication of sublingual immunotherapy

Introduction. Eosinophilic esophagitis (EoE) represents chronic, a local immune-mediated disease with symptoms of esophageal dysfunction and histologically eosinophil-predominant inflammation and requires immediate endoscopy. Male gender is a strong risk factor. Case report. We presented a case of a...

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Autores principales:	Knežević Snežana B., Dugalić Branimir D.
Formato:	article
Lenguaje:	EN SR
Publicado:	Serbian Medical Society, Belgrade 2021
Materias:	eosinophilic esophagitis dysphagia food bolus impaction sublingual immunotherapy Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/6f82228eeccf4e7d9f059e3b8b021bf8
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spelling	oai:doaj.org-article:6f82228eeccf4e7d9f059e3b8b021bf82021-12-05T21:29:00ZEosinophilic esophagitis: A potential complication of sublingual immunotherapy0354-71322217-399410.5937/opmed2102032Khttps://doaj.org/article/6f82228eeccf4e7d9f059e3b8b021bf82021-01-01T00:00:00Zhttps://scindeks-clanci.ceon.rs/data/pdf/0354-7132/2021/0354-71322101032K.pdfhttps://doaj.org/toc/0354-7132https://doaj.org/toc/2217-3994Introduction. Eosinophilic esophagitis (EoE) represents chronic, a local immune-mediated disease with symptoms of esophageal dysfunction and histologically eosinophil-predominant inflammation and requires immediate endoscopy. Male gender is a strong risk factor. Case report. We presented a case of a 25-year-old young man with a history of allergic rhino-conjunctivitis, asthma, and intermittent severe feeding disturbance. The patient had begun sublingual immunotherapy therapy, containing specific soluble allergens for ambrosia. Six weeks after starting the ambrosia sublingual immunotherapy he developed burning epigastric pain, dysphagia, and odynophagia. Six days later, he was admitted to an emergency department due to choking on a solid of food. Esophageal histopathological findings were in favor of EoE. Sublingual immunotherapy was discontinued. He feels well now. Conclusion. The majority of cases of Eosinophilic esophagitis are diagnosed in spring or fall, 1-2 months following the peak of pollen season. Dysphagia, chest pain, food sticking, and bolus obstruction are the most common symptoms. Endoscopic findings are Schatzki ring, edema, exudates, furrows, and strictures. Six biopsies should be taken from areas with endoscopic mucosal abnormalities, and infiltration of eosinophils (more than 15 eosinophils/HRI) (HRI - high resolution imaging) is necessary for the diagnosis confirmation. Treatment options are proton pump inhibitors - oral dispersible tablets of budesonide or fluticasone propionate, an elimination diet. Sublingual immunotherapy should be discontinued. Family physicians should be aware of this complication in evaluating patients with dysphagia.Knežević Snežana B.Dugalić Branimir D.Serbian Medical Society, Belgradearticleeosinophilic esophagitisdysphagiafood bolus impactionsublingual immunotherapyMedicine (General)R5-920ENSROpšta Medicina, Vol 27, Iss 1-2, Pp 32-39 (2021)
institution	DOAJ
collection	DOAJ
language	EN SR
topic	eosinophilic esophagitis dysphagia food bolus impaction sublingual immunotherapy Medicine (General) R5-920
spellingShingle	eosinophilic esophagitis dysphagia food bolus impaction sublingual immunotherapy Medicine (General) R5-920 Knežević Snežana B. Dugalić Branimir D. Eosinophilic esophagitis: A potential complication of sublingual immunotherapy
description	Introduction. Eosinophilic esophagitis (EoE) represents chronic, a local immune-mediated disease with symptoms of esophageal dysfunction and histologically eosinophil-predominant inflammation and requires immediate endoscopy. Male gender is a strong risk factor. Case report. We presented a case of a 25-year-old young man with a history of allergic rhino-conjunctivitis, asthma, and intermittent severe feeding disturbance. The patient had begun sublingual immunotherapy therapy, containing specific soluble allergens for ambrosia. Six weeks after starting the ambrosia sublingual immunotherapy he developed burning epigastric pain, dysphagia, and odynophagia. Six days later, he was admitted to an emergency department due to choking on a solid of food. Esophageal histopathological findings were in favor of EoE. Sublingual immunotherapy was discontinued. He feels well now. Conclusion. The majority of cases of Eosinophilic esophagitis are diagnosed in spring or fall, 1-2 months following the peak of pollen season. Dysphagia, chest pain, food sticking, and bolus obstruction are the most common symptoms. Endoscopic findings are Schatzki ring, edema, exudates, furrows, and strictures. Six biopsies should be taken from areas with endoscopic mucosal abnormalities, and infiltration of eosinophils (more than 15 eosinophils/HRI) (HRI - high resolution imaging) is necessary for the diagnosis confirmation. Treatment options are proton pump inhibitors - oral dispersible tablets of budesonide or fluticasone propionate, an elimination diet. Sublingual immunotherapy should be discontinued. Family physicians should be aware of this complication in evaluating patients with dysphagia.
format	article
author	Knežević Snežana B. Dugalić Branimir D.
author_facet	Knežević Snežana B. Dugalić Branimir D.
author_sort	Knežević Snežana B.
title	Eosinophilic esophagitis: A potential complication of sublingual immunotherapy
title_short	Eosinophilic esophagitis: A potential complication of sublingual immunotherapy
title_full	Eosinophilic esophagitis: A potential complication of sublingual immunotherapy
title_fullStr	Eosinophilic esophagitis: A potential complication of sublingual immunotherapy
title_full_unstemmed	Eosinophilic esophagitis: A potential complication of sublingual immunotherapy
title_sort	eosinophilic esophagitis: a potential complication of sublingual immunotherapy
publisher	Serbian Medical Society, Belgrade
publishDate	2021
url	https://doaj.org/article/6f82228eeccf4e7d9f059e3b8b021bf8
work_keys_str_mv	AT knezevicsnezanab eosinophilicesophagitisapotentialcomplicationofsublingualimmunotherapy AT dugalicbranimird eosinophilicesophagitisapotentialcomplicationofsublingualimmunotherapy
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Eosinophilic esophagitis: A potential complication of sublingual immunotherapy

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