Immunotherapy. 2025 Nov 2:1-5. doi: 10.1080/1750743X.2025.2578444. Online ahead of print.
ABSTRACT
BACKGROUND: Oral immunotherapy (OIT) is an emerging treatment for IgE-mediated food allergy, but eosinophilic esophagitis (EoE) has been reported as a potential complication, especially with milk and egg. Data on wheat OIT are limited. This study examined the incidence, course, and outcomes of EoE in children undergoing wheat OIT.
METHODS: We retrospectively reviewed 79 children with confirmed IgE-mediated wheat allergy treated with OIT between 2020 and 2023 at two tertiary centers in Iran. Patients with suspected EoE underwent endoscopy with histopathology. Diagnosis required ≥15 eosinophils/high-power field. Management included wheat elimination and proton pump inhibitors (PPIs) ± topical corticosteroids.
RESULTS: Eight of 79 patients (10.1%) developed EoE. Seven became symptomatic during up-dosing or early maintenance; one asymptomatic patient was diagnosed at parental request. Histopathology confirmed 18-110 eosinophils/HPF. All symptomatic cases improved after OIT discontinuation and medical therapy. No severe anaphylaxis occurred. Follow-up endoscopy was limited by patient refusal.
CONCLUSION: EoE occurred in 10% of children during wheat OIT, mainly in the up-dosing phase. While symptoms resolved with treatment and cessation, distinguishing transient OIT-induced eosinophilia from persistent EoE remains critical. Prospective studies with pre- and post-OIT endoscopy are needed to guide monitoring and management.
PMID:41176711 | DOI:10.1080/1750743X.2025.2578444
