Author Topic: Does SLIT cause Eosinophilic Esophagitis in some patients? (Read 6313 times)

luci · « **on:** June 15, 2012, 05:53:57 PM »

I heard from a reliable source, that SLIT caused 25% of patients undergoing this therapy to develop EoE. I've been trying to find the study that showed these findings, but haven't been able to so far.

Does anyone know where I might find this paper?

Thanks!

CMdeux · « **Reply #1 on:** June 15, 2012, 06:26:05 PM »

I, like you, have heard this statement made by several people who are generally extremely reliable about such things...

but I've not yet seen the publication-- assuming that one exists at this point. I'm guessing, based on past history, that this may be a pre-publication finding from an in-progress study, or one recently wrapped up.

There must be something to it, though-- because I've heard the estimate 15-20% from one person, and "about one in five" from another. Your estimate is too close to either of those to be pure coincidence.

This is also something that I've heard is a concern (? and maybe more than a concern-- maybe "observed side effect" even) in oral immunotherapy trials, though the numbers are pretty small in those trials, so it's not yet clear to me that they really know incidence very well.

Macabre · « **Reply #2 on:** June 15, 2012, 06:51:18 PM »

I think it was mentioned at AAAAI. I may have posted a tweet about it. But not just with SLIT--OIT.

booandbrimom · « **Reply #3 on:** June 15, 2012, 11:49:19 PM »

We were told there is some risk of EoE getting worse with the FAHF-2, or at least that it's a concern. They were very careful to screen my son for EoE (he had symptoms a couple years ago that were questionable).

Here's a study reference:

http://f1000.com/8412958

hk · « **Reply #4 on:** June 16, 2012, 05:15:55 PM »

Thanks for posting. I had not heard that. I will ask allergist if he knows anything when we see him in a few weeks. Having been recently diagnosed with EoE, I certainly don't want dd to go through what I'm going through. Another thing to consider anyway.

luci · « **Reply #5 on:** June 21, 2012, 02:43:13 PM »

I was finally able to check with our allergist's office and the nurse said she had no knowledge of SLIT causing EE in any of their patients. This is the LaCrosse clinic - the clinic with the protocols that call for really small doses of the allergens. So maybe it's that the small doses are causing EE and the larger doses for SLIT and OIT are causing EE in some patients?

Please feel free to let me know if you find any information that is different.

lakeswimr · « **Reply #6 on:** June 22, 2012, 09:37:51 AM »

My son's allergist said that it can happen when people get stomach aches and push through those symptoms. I know someone who pushed through stomach symptoms and her child is no longer allergic to that particular food, though, so it is a risk but apparently doesn't happen to everyone.

ajasfolks2 · « **Reply #7 on:** August 23, 2013, 11:45:04 AM »

Wondering if anyone has found study and/or other article published by medical authority that addresses this?

If so, please share and post links (cross post if those links are elsewhere and my addled brain does not recall).

Thanks!

ajasfolks2 · « **Reply #8 on:** August 23, 2013, 11:47:55 AM »

So, I do quick Google and this is second hit (first hit was this thread here!):

Disclaimer, have not read blog post all the way through . . .

http://angryallergist.squarespace.com/the-angry-allergist-journal/2008/1/6/advanced-slit-case-history-101-eosinophilic-esophagitis-migr.html

ajasfolks2 · « **Reply #9 on:** August 23, 2013, 11:51:48 AM »

Other hits I got, possibly related (or not):

http://allergynotes.blogspot.com/2012/02/eosinophilic-esophagitis-eoe-twitter.html

Macabre · « **Reply #10 on:** August 23, 2013, 12:52:51 PM »

Dr. Mary Morris at La Crosse has said they have seen no reported cases of EoE with their SLIT patients (DS is doing SLIT). Her practice has being doing it for environmentals for around 30 years I think and for FAs for some time (don't know how long and don't have time to check right now).

However, they start with uber small doses--much smaller than what is used in trials typically. And her goal is not consuming the food allergen but increased tolerance to accidental ingestion.

CMdeux · « **Reply #11 on:** August 23, 2013, 01:29:25 PM »

Our info from allergist suggests that this has been a problem in rapid, oral desensitization rather than in SLIT or very low-dose baked milk/egg immunotherapy.

It is a reason why we've chosen not to push harder/faster on the tolerance with a baked dosing protocol, though.

hk · « **Reply #12 on:** August 24, 2013, 12:00:41 PM »

Quote from: CMdeux on August 23, 2013, 01:29:25 PM

Our info from allergist suggests that this has been a problem in rapid, oral desensitization rather than in SLIT or very low-dose baked milk/egg immunotherapy.

It is a reason why we've chosen not to push harder/faster on the tolerance with a baked dosing protocol, though.

That's what our allergist said as well. His understanding is that the Stanford multi allergen OIT study is pretty rapid/aggressive and that about 20% of participants developed EoE during that study. That said, I know some participants in that study and they have all been fine.