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Eosinophilic Esophagitis: an Important Comorbid Condition of Asthma?

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Abstract

Eosinophilic esophagitis and asthma are frequently found as comorbid conditions in children and adults along with other manifestations of atopic diathesis. These two conditions have similar T helper 2 responses-driven pathophysiology and share common management strategies such as using systemic corticosteroids and targeted anti-cytokine biologic therapies. Review of the literature finds that asthma is often a comorbid condition in eosinophilic esophagitis in both children and adults; however, the EoE-asthma relationship remains poorly characterized mechanistically and clinically. EoE and asthma commonly share several comorbid conditions such as allergic rhinitis and gastroesophageal reflux disease; therefore, addressing these comorbid conditions has the potential to improve and/or maintain control in both diseases. Similar to asthma, patients with EoE frequently demonstrate elevations in serum markers of atopy, including serum IgE levels, peripheral eosinophil counts, and T helper 2-related cytokines. Gastroesophageal reflux disease is thought to affect asthma through microaspirations, airway hyperresponsiveness, and increased vagal tone. The understanding of the relationship between gastroesophageal reflux and EoE is still evolving but seems to be bidirectional and interactive. In terms of treatment, similar classes of medications have been used in both EoE and asthma. In both children and adults, EoE remission can be achieved by food trigger avoidance and use of corticosteroids and biologic therapies. Asthma control is mostly achieved through inhaled corticosteroids, and long but biologic therapies are increasingly used in severe subsets of the disease. Significant clinical and mechanistic work needs to be accomplished to better understand the relationship between asthma, EoE, and their interaction with other allergic diseases. Understanding whether shared mechanisms exist can lead to the development of new diagnostic and therapeutic strategies. The following review examines the existing literature regarding prevalence, common comorbidities, and potential therapeutic approach and identifies gaps in knowledge and future directions.

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Abbreviations

Ab:

Antibody

CS:

Corticosteroid

EoE:

Eosinophilic esophagitis

EGF:

Epidermal growth factor

FGF-2:

Fibroblast growth factor 2

TSLP:

Thymic stromal lymphopoietin

GERD:

Gastroesophageal reflux disease

ICS:

Inhaled corticosteroid

PPI:

Proton pump inhibitor

PPI-REE:

Proton pump inhibitor-responsive esophageal eosinophilia

SCS:

Swallowed corticosteroid

TH2 :

T helper 2

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Funding

This work (VM) was supported by the NIH Grant U54 AI117804. The Consortium for Eosinophilic Gastrointestinal Disease Researchers (CEGIR, U54 AI117804) is part of the Rare Diseases Clinical Research Network (RDCRN), an initiative of the Office of Rare Diseases Research (ORDR), NCATS, and is funded through collaboration between NIAID, NIDDK, and NCATS. CEGIR is also supported by patient advocacy groups including the American Partnership for Eosinophilic Disorders (APFED), Campaign Urging Research for Eosinophilic Diseases (CURED), and Eosinophilic Family Coalition (EFC).

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Authors and Affiliations

  1. Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA

    Sandy R. Durrani

  2. Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Sandy R. Durrani & Theresa W. Guilbert

  3. Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Sandy R. Durrani, Vincent A. Mukkada & Theresa W. Guilbert

  4. Division of Gastroenterology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Vincent A. Mukkada

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  1. Sandy R. Durrani
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  2. Vincent A. Mukkada
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  3. Theresa W. Guilbert
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Correspondence to Sandy R. Durrani.

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Dr. Durrani reports funding from Sanofi/Regeneron.

Dr. Mukkada reports funding from the NIH, PCORI, and Shire. He has done consulting work with hire.

Dr. Guilbert reports personal fees from the American Board of Pediatrics; Pediatric Pulmonary Subboard, personal fees from Teva, personal fees from GSK, personal fees from Regeneron Pharmaceuticals, grants from NIH, other from UpToDate, personal fees from Merck, grants and personal fees from Sanofi/Regeneron, personal fees from Novartis/Regeneron, personal fees from Aviragen, and personal fees from GSK/Regneron, outside the submitted work.

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Durrani, S.R., Mukkada, V.A. & Guilbert, T.W. Eosinophilic Esophagitis: an Important Comorbid Condition of Asthma?. Clinic Rev Allerg Immunol 55, 56–64 (2018). https://doi.org/10.1007/s12016-018-8670-7

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