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Eosinophils and allergic diseases of the gastrointestinal tract

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The association between increased tissue eosinophilia and allergic disease is particularly striking in the case of the gastrointestinal tract. About 80% of individuals with eosinophilic gastrointestinal disorders (EGIDs) are atopic, while half of the patients with gastrointestinal allergy show tissue eosinophilia. The function of eosinophils in gastrointestinal allergic disorders is unclear; however, a proinflammatory action is most likely. Cytokines (interleukins 5 and 3, granulocyte-monocyte colony-stimulating factor) and chemokines (eotaxin, RANTES, etc.) released by Th2 lymphocytes, mast cells and other tissue cells have been identified as major regulators of eosinophil chemotaxis and activation, but a convincing mechanism by which eosinophils are activated in an allergen-dependent manner is still lacking. The diagnostic approach comprises both histological and laboratory methods to assess eosinophilia and eosinophil activation, as well as tools to assess the allergic disease while excluding other gastrointestinal diseases such as food intolerances, infections and tumours. Treatment of allergic EGIDs includes elimination or elemental diets and drug therapy using classical anti-allergic agents such as topical corticosteroids and new approaches such as LTD4 receptor antagonists or antibodies against IL-5 or eotaxin.

Section snippets

Regulation of intestinal immune responses

The intestinal mucosa has to meet the challenge of protecting the host against possibly harmful nutrients, microbes and toxins on the one hand, while on the other hand ensuring the uptake of nutrients and antigens indispensable for life.5 To do this, the gastrointestinal barrier is equipped with an innate immune system and other non-specific defence systems, including gastric acid, mucus and bicarbonate secretion, as well as an intact epithelial layer forming tight junctions, peristaltic

Association between eosinophils and allergy

Eosinophils have been proposed as major contributors to allergic inflammation, because they are typically found in increased numbers at sites of allergic inflammation, and they are activated for mediator release in the course of type-I allergic reactions. The factors responsible for eosinophil recruitment are mostly identified, and include interleukins (IL-5, and to a lesser extent IL-3 and GM-CSF) and chemokines (e.g. eotaxin and RANTES; for details see Chapter 2 of the issue). The mechanisms

Clinical presentation of allergic diseases in the gastrointestinal tract

Allergic symptoms vary from marginal impairments to life-threatening shock reactions. Major targets of food allergy are the skin, the respiratory tract and the gastrointestinal tract (Table 3), either alone or in combination.38, 39 Possibly the gastrointestinal tract is the primary ‘allergy organ’, since it forms the largest barrier of the host to the environment (∼400 qm, compared to skin, 2 qm), it is exposed to huge amounts of antigen (40 g food proteins per day, of which 2% are not hydrolysed

Eosinophilic oesophagitis

The presence of eosinophils in the oesophagus indicates an abnormal situation, since the oesophagus is usually devoid of eosinophils.60 Such conditions typically occur in association with allergic disease, or remain idiopathic, but finally they cause chronic inflammation independent of the aetiology of disease.

Two different subtypes of eosinophil-associated oesophageal disorders are differentiated: primary and secondary. Atopic, non-atopic, and familial forms belong to the primary subtype,

Diagnostic means for confirming allergic eosinophilic diseases

The principle of the diagnostic approach is to combine the diagnostic means for EGIDs, as described in Chapters 3 and 4, with those for allergic diseases, while excluding other gastrointestinal diseases such as food intolerances, IBD, IBS, infections, and tumour diseases.

The first step for the evaluation of a possible allergic EGID is obtaining a detailed history of atopy and ARF.4 Extraintestinal manifestations of allergy such as hay fever, asthma, an atopic dermatitis, high total IgE levels

Dietetic management

The basis of any successful treatment of confirmed food allergy is an elimination diet, regardless of whether eosinophils are involved or not. This requires not only that the diagnosis be confirmed but also that the relevant offending food components be identified. Both IgE-dependent and IgE-independent mechanisms can be involved. Food elimination based solely on SPT have not been efficacious, but exclusion of food identified by a combination of SPT and patch testing has shown good success

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