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Published in: Clinical Journal of Gastroenterology 1/2024

30-11-2023 | Eosinophilic Esophagitis | Case Report

Sublingual immunotherapy for cedar pollinosis possibly triggers eosinophilic esophagitis

Authors: Toshio Yamagata, Hirokazu Saito, Atsushi Fujimoto, Kana Oomoto, Akiko Ikebata, Joji Urata, Motohiko Tanaka, Yasuo Toyozumi, Shuji Tada, Shunpei Hashigo

Published in: Clinical Journal of Gastroenterology | Issue 1/2024

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Abstract

Sublingual immunotherapy (SLIT) is an effective and popular treatment for cedar pollinosis. Although SLIT can cause allergic side effects, eosinophilic esophagitis (EoE) is a lesser-known side effect of SLIT. A 26-year-old male with cedar pollinosis, wheat-dependent exercise-induced anaphylaxis, and food allergies to bananas and avocados presented with persistent throat itching, difficulty swallowing, heartburn, and anterior chest pain 8 days after starting SLIT for cedar pollinosis. Laboratory examination showed remarkably elevated eosinophils, and esophagogastroduodenoscopy revealed linear furrows in the entire esophagus. Histological examination of an esophageal biopsy specimen revealed high eosinophil levels. The patient was strongly suspected with EoE triggered by SLIT. The patient was advised to switch from the swallow to the spit method for SLIT, and the symptoms associated with SLIT-triggered EoE were reduced after switching to the spit method. This case highlights the importance of recognizing SLIT-triggered EoE as a potential side effect of SLIT for cedar pollinosis, especially with the increasing use of SLIT in clinical practice. EoE can occur within a month after initiating SLIT in patients with multiple allergic conditions, as observed in our case. Furthermore, the spit method should be recommended for patients who experience SLIT-triggered EoE before discontinuing SLIT.
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Metadata
Title
Sublingual immunotherapy for cedar pollinosis possibly triggers eosinophilic esophagitis
Authors
Toshio Yamagata
Hirokazu Saito
Atsushi Fujimoto
Kana Oomoto
Akiko Ikebata
Joji Urata
Motohiko Tanaka
Yasuo Toyozumi
Shuji Tada
Shunpei Hashigo
Publication date
30-11-2023
Publisher
Springer Nature Singapore
Published in
Clinical Journal of Gastroenterology / Issue 1/2024
Print ISSN: 1865-7257
Electronic ISSN: 1865-7265
DOI
https://doi.org/10.1007/s12328-023-01881-z

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