Baseline gastrointestinal eosinophilia is common in oral immunotherapy subjects with IgE-mediated peanut allergy

Benjamin Wright, Nielsen Q. Fernandez-Becker, Neeraja Kambham, Natasha Purington, Dana Tupa, Wenming Zhang, Matthew A Rank, Hirohito Kita, Kelly P. Shim, Bryan J. Bunning, Alfred D. Doyle, Elizabeth Jacobsen, Scott D. Boyd, Mindy Tsai, Holden Maecker, Monali Manohar, Stephen J. Galli, Kari C. Nadeau, R. Sharon Chinthrajah

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Rationale: Oral immunotherapy (OIT) is an emerging treatment for food allergy. While desensitization is achieved in most subjects, many experience gastrointestinal symptoms and few develop eosinophilic gastrointestinal disease. It is unclear whether these subjects have subclinical gastrointestinal eosinophilia (GE) at baseline. We aimed to evaluate the presence of GE in subjects with food allergy before peanut OIT. Methods: We performed baseline esophagogastroduodenoscopies on 21 adults before undergoing peanut OIT. Subjects completed a detailed gastrointestinal symptom questionnaire. Endoscopic findings were assessed using the Eosinophilic Esophagitis (EoE) Endoscopic Reference Score (EREFS) and biopsies were obtained from the esophagus, gastric antrum, and duodenum. Esophageal biopsies were evaluated using the EoE Histologic Scoring System. Immunohistochemical staining for eosinophil peroxidase (EPX) was also performed. Hematoxylin and eosin and EPX stains of each biopsy were assessed for eosinophil density and EPX/mm2 was quantified using automated image analysis. Results: All subjects were asymptomatic. Pre-existing esophageal eosinophilia (>5 eosinophils per high-power field [eos/hpf]) was present in five participants (24%), three (14%) of whom had >15 eos/hpf associated with mild endoscopic findings (edema, linear furrowing, or rings; median EREFS = 0, IQR 0-0.25). Some subjects also demonstrated basal cell hyperplasia, dilated intercellular spaces, and lamina propria fibrosis. Increased eosinophils were noted in the gastric antrum (>12 eos/hpf) or duodenum (>26 eos/hpf) in 9 subjects (43%). EPX/mm2 correlated strongly with eosinophil counts (r = 0.71, p < 0.0001). Conclusions: Pre-existing GE is common in adults with IgE-mediated peanut allergy. Eosinophilic inflammation (EI) in these subjects may be accompanied by mild endoscopic and histologic findings. Longitudinal data collection during OIT is ongoing.

Original languageEnglish (US)
Article number02624
JournalFrontiers in Immunology
Volume9
Issue numberNOV
DOIs
StatePublished - Nov 22 2018

Fingerprint

Peanut Hypersensitivity
Eosinophilia
Eosinophils
Immunotherapy
Immunoglobulin E
Eosinophil Peroxidase
Eosinophilic Esophagitis
Pyloric Antrum
Food Hypersensitivity
Biopsy
Duodenum
Digestive System Endoscopy
Gastrointestinal Diseases
Extracellular Space
Hematoxylin
Eosine Yellowish-(YS)
Esophagus
Hyperplasia
Edema
Mucous Membrane

Keywords

  • adverse event
  • biopsy
  • endoscopy
  • eosinophil
  • Eosinophilic Esophagitis
  • gastrointestinal
  • oral immunotherapy
  • peanut food allergy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Wright, B., Fernandez-Becker, N. Q., Kambham, N., Purington, N., Tupa, D., Zhang, W., ... Chinthrajah, R. S. (2018). Baseline gastrointestinal eosinophilia is common in oral immunotherapy subjects with IgE-mediated peanut allergy. Frontiers in Immunology, 9(NOV), [02624]. https://doi.org/10.3389/fimmu.2018.02624

Baseline gastrointestinal eosinophilia is common in oral immunotherapy subjects with IgE-mediated peanut allergy. / Wright, Benjamin; Fernandez-Becker, Nielsen Q.; Kambham, Neeraja; Purington, Natasha; Tupa, Dana; Zhang, Wenming; Rank, Matthew A; Kita, Hirohito; Shim, Kelly P.; Bunning, Bryan J.; Doyle, Alfred D.; Jacobsen, Elizabeth; Boyd, Scott D.; Tsai, Mindy; Maecker, Holden; Manohar, Monali; Galli, Stephen J.; Nadeau, Kari C.; Chinthrajah, R. Sharon.

In: Frontiers in Immunology, Vol. 9, No. NOV, 02624, 22.11.2018.

Research output: Contribution to journalArticle

Wright, B, Fernandez-Becker, NQ, Kambham, N, Purington, N, Tupa, D, Zhang, W, Rank, MA, Kita, H, Shim, KP, Bunning, BJ, Doyle, AD, Jacobsen, E, Boyd, SD, Tsai, M, Maecker, H, Manohar, M, Galli, SJ, Nadeau, KC & Chinthrajah, RS 2018, 'Baseline gastrointestinal eosinophilia is common in oral immunotherapy subjects with IgE-mediated peanut allergy', Frontiers in Immunology, vol. 9, no. NOV, 02624. https://doi.org/10.3389/fimmu.2018.02624
Wright, Benjamin ; Fernandez-Becker, Nielsen Q. ; Kambham, Neeraja ; Purington, Natasha ; Tupa, Dana ; Zhang, Wenming ; Rank, Matthew A ; Kita, Hirohito ; Shim, Kelly P. ; Bunning, Bryan J. ; Doyle, Alfred D. ; Jacobsen, Elizabeth ; Boyd, Scott D. ; Tsai, Mindy ; Maecker, Holden ; Manohar, Monali ; Galli, Stephen J. ; Nadeau, Kari C. ; Chinthrajah, R. Sharon. / Baseline gastrointestinal eosinophilia is common in oral immunotherapy subjects with IgE-mediated peanut allergy. In: Frontiers in Immunology. 2018 ; Vol. 9, No. NOV.
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abstract = "Rationale: Oral immunotherapy (OIT) is an emerging treatment for food allergy. While desensitization is achieved in most subjects, many experience gastrointestinal symptoms and few develop eosinophilic gastrointestinal disease. It is unclear whether these subjects have subclinical gastrointestinal eosinophilia (GE) at baseline. We aimed to evaluate the presence of GE in subjects with food allergy before peanut OIT. Methods: We performed baseline esophagogastroduodenoscopies on 21 adults before undergoing peanut OIT. Subjects completed a detailed gastrointestinal symptom questionnaire. Endoscopic findings were assessed using the Eosinophilic Esophagitis (EoE) Endoscopic Reference Score (EREFS) and biopsies were obtained from the esophagus, gastric antrum, and duodenum. Esophageal biopsies were evaluated using the EoE Histologic Scoring System. Immunohistochemical staining for eosinophil peroxidase (EPX) was also performed. Hematoxylin and eosin and EPX stains of each biopsy were assessed for eosinophil density and EPX/mm2 was quantified using automated image analysis. Results: All subjects were asymptomatic. Pre-existing esophageal eosinophilia (>5 eosinophils per high-power field [eos/hpf]) was present in five participants (24{\%}), three (14{\%}) of whom had >15 eos/hpf associated with mild endoscopic findings (edema, linear furrowing, or rings; median EREFS = 0, IQR 0-0.25). Some subjects also demonstrated basal cell hyperplasia, dilated intercellular spaces, and lamina propria fibrosis. Increased eosinophils were noted in the gastric antrum (>12 eos/hpf) or duodenum (>26 eos/hpf) in 9 subjects (43{\%}). EPX/mm2 correlated strongly with eosinophil counts (r = 0.71, p < 0.0001). Conclusions: Pre-existing GE is common in adults with IgE-mediated peanut allergy. Eosinophilic inflammation (EI) in these subjects may be accompanied by mild endoscopic and histologic findings. Longitudinal data collection during OIT is ongoing.",
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T1 - Baseline gastrointestinal eosinophilia is common in oral immunotherapy subjects with IgE-mediated peanut allergy

AU - Wright, Benjamin

AU - Fernandez-Becker, Nielsen Q.

AU - Kambham, Neeraja

AU - Purington, Natasha

AU - Tupa, Dana

AU - Zhang, Wenming

AU - Rank, Matthew A

AU - Kita, Hirohito

AU - Shim, Kelly P.

AU - Bunning, Bryan J.

AU - Doyle, Alfred D.

AU - Jacobsen, Elizabeth

AU - Boyd, Scott D.

AU - Tsai, Mindy

AU - Maecker, Holden

AU - Manohar, Monali

AU - Galli, Stephen J.

AU - Nadeau, Kari C.

AU - Chinthrajah, R. Sharon

PY - 2018/11/22

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N2 - Rationale: Oral immunotherapy (OIT) is an emerging treatment for food allergy. While desensitization is achieved in most subjects, many experience gastrointestinal symptoms and few develop eosinophilic gastrointestinal disease. It is unclear whether these subjects have subclinical gastrointestinal eosinophilia (GE) at baseline. We aimed to evaluate the presence of GE in subjects with food allergy before peanut OIT. Methods: We performed baseline esophagogastroduodenoscopies on 21 adults before undergoing peanut OIT. Subjects completed a detailed gastrointestinal symptom questionnaire. Endoscopic findings were assessed using the Eosinophilic Esophagitis (EoE) Endoscopic Reference Score (EREFS) and biopsies were obtained from the esophagus, gastric antrum, and duodenum. Esophageal biopsies were evaluated using the EoE Histologic Scoring System. Immunohistochemical staining for eosinophil peroxidase (EPX) was also performed. Hematoxylin and eosin and EPX stains of each biopsy were assessed for eosinophil density and EPX/mm2 was quantified using automated image analysis. Results: All subjects were asymptomatic. Pre-existing esophageal eosinophilia (>5 eosinophils per high-power field [eos/hpf]) was present in five participants (24%), three (14%) of whom had >15 eos/hpf associated with mild endoscopic findings (edema, linear furrowing, or rings; median EREFS = 0, IQR 0-0.25). Some subjects also demonstrated basal cell hyperplasia, dilated intercellular spaces, and lamina propria fibrosis. Increased eosinophils were noted in the gastric antrum (>12 eos/hpf) or duodenum (>26 eos/hpf) in 9 subjects (43%). EPX/mm2 correlated strongly with eosinophil counts (r = 0.71, p < 0.0001). Conclusions: Pre-existing GE is common in adults with IgE-mediated peanut allergy. Eosinophilic inflammation (EI) in these subjects may be accompanied by mild endoscopic and histologic findings. Longitudinal data collection during OIT is ongoing.

AB - Rationale: Oral immunotherapy (OIT) is an emerging treatment for food allergy. While desensitization is achieved in most subjects, many experience gastrointestinal symptoms and few develop eosinophilic gastrointestinal disease. It is unclear whether these subjects have subclinical gastrointestinal eosinophilia (GE) at baseline. We aimed to evaluate the presence of GE in subjects with food allergy before peanut OIT. Methods: We performed baseline esophagogastroduodenoscopies on 21 adults before undergoing peanut OIT. Subjects completed a detailed gastrointestinal symptom questionnaire. Endoscopic findings were assessed using the Eosinophilic Esophagitis (EoE) Endoscopic Reference Score (EREFS) and biopsies were obtained from the esophagus, gastric antrum, and duodenum. Esophageal biopsies were evaluated using the EoE Histologic Scoring System. Immunohistochemical staining for eosinophil peroxidase (EPX) was also performed. Hematoxylin and eosin and EPX stains of each biopsy were assessed for eosinophil density and EPX/mm2 was quantified using automated image analysis. Results: All subjects were asymptomatic. Pre-existing esophageal eosinophilia (>5 eosinophils per high-power field [eos/hpf]) was present in five participants (24%), three (14%) of whom had >15 eos/hpf associated with mild endoscopic findings (edema, linear furrowing, or rings; median EREFS = 0, IQR 0-0.25). Some subjects also demonstrated basal cell hyperplasia, dilated intercellular spaces, and lamina propria fibrosis. Increased eosinophils were noted in the gastric antrum (>12 eos/hpf) or duodenum (>26 eos/hpf) in 9 subjects (43%). EPX/mm2 correlated strongly with eosinophil counts (r = 0.71, p < 0.0001). Conclusions: Pre-existing GE is common in adults with IgE-mediated peanut allergy. Eosinophilic inflammation (EI) in these subjects may be accompanied by mild endoscopic and histologic findings. Longitudinal data collection during OIT is ongoing.

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KW - biopsy

KW - endoscopy

KW - eosinophil

KW - Eosinophilic Esophagitis

KW - gastrointestinal

KW - oral immunotherapy

KW - peanut food allergy

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