Auckland Allergy Clinic ? WHAT?S NEW February 2006

Welcome to the Auckland Allergy Clinic web site. This section will bring you the latest breaking news in Allergy & Clinical Immunology and also additions we have made to the Clinic in the last month.

The Allergy News information provided on this web site is reviewed and approved by the Allergists at the Auckland Allergy Clinic. The information is sourced from International Medical Journals and Newspapers. These articles are chosen either because they are thought to be particularly good studies, very interesting Allergy News or relevant to New Zealand. The articles may not necessarily be the views of the editor. Where relevant the editor will add his/her comments at the bottom of the review.

These updates are provided for educational, communication and information purposes only.

Previous Newsletters:

May 2005

October 2004
August 2004
March 2004
January 2004

Allergic Eosinophilic Esophagitis

Vincent St Aubyn Crump ? February 2006

EE was first described by Attwood et al as a distinct clinical entity in 1993. He reported a series of 12 patients with isolated oesophageal eosinophilia and reflux (1).

Clinical Features include:
" The patients presented with dysphagia and had visually normal oesophageal mucosa, >20 oesophinils per HPF on biopsy (mean 56 eosinophils /HPF
" Normal 24 hour pH probe monitoring (no reflux) in 11 patients
" Allergic diseases in 7 patients

In 1995 Hugh Sampson et al described a series of 10 children with abdominal pain after eating, early satiety or food refusal, vomiting or retching, failure to thrive, and non-responsiveness to standard medical therapy (2).

All these patients were treated for several years with various antacids and H2-antihistamines (Ranitidine and Cimetidine), prokinetic agents (omeprazole), and oral steroids. 4 out of the 10 even had a surgical procedure (Nissan fundoplication) for their persistent ?reflux? and vomiting.

On endoscopy these patients had normal looking oesophageal mucosa, but marked eosinophilia on microscopy.

Following 6-8 weeks of an amino acid-based formula (Neocate) plus rice, symptoms completely resolved in 8 patients and markedly improved in the other 2.

Improvement (decreased eosinophilia) was also seen on repeat biopsy.

Symptoms could be reproduced with the introduction of certain foods. This study clearly implicated food hypersensitivity in patients with allergic eosinophilic espohagitis.