PURPOSE OF REVIEW Eosinophilic esophagitis (EoE) is a relatively new disease but its understanding is evolving over a period of time. This review highlights recent advances in the understanding of pathophysiology, diagnostic modalities, short and long-term goals of therapy and novel therapeutic agents. RECENT FINDINGS The prevalence of EoE is increasing. Upper endoscopy and biopsy remains the gold standard for diagnosing EoE but less invasive and more cost-effective testing has been under investigation. Scoring systems to assess symptoms, histology and endoscopic findings can distinguish between active and inactive disease. Step up therapy with 2-4-6 food elimination can result in early identification of triggering foods and reduce frequency of endoscopies. The term proton pump inhibitor (PPI) responsive eosinophilia should be avoided and PPI should be considered a therapeutic modality. Oral viscous budesonide has been more effective than fluticasone in achieving remission. Adrenal suppression should be looked for patients on swallowed steroids. IL-13 antagonists can be a promising therapy for EoE and dilation is a safe and effective treatment modality in patients with EoE but as is expected, does not decrease inflammation. SUMMARY EoE has been increasingly recognized as a cause of food impactions and dysphagia. Less invasive methods for diagnosis and to monitor treatment response have been studied but need validation in children. Short-term treatment goals include symptomatic and histological improvement, with prevention of fibrostenotic disease the primary long-term goal. Elemental diet and empiric elimination diet appear to be successful in inducing remission. PPI and swallowed steroids cause symptomatic improvement and histological remission but relapse is common after discontinuation of therapy.

Eosinophilic esophagitis: short and long-term considerations.

Allergic responses represent a significant health problem due to the ineffectiveness of current treatments, as they attempt to decrease the immune response triggered but are unable to create immune memory that reduces the intensity of such response, so the intensity of the response will always be the same as the first time. An allergic response is characterized by the exacerbated and prolonged release of immunoglobulin E (IgE) that triggers innate immune responses due to the activation of T lymphocytes towards a Th2 phenotype, responsible for the release of interleukins 3 and 4 (IL-3 and IL-4), and the activation of B lymphocytes towards IgE-producing plasma cells. Currently, monoclonal antibodies (mAbs) are used as treatment for various allergic pathologies as they can be used to inhibit the signaling pathways of various interleukins, inactivating the differentiation of T lymphocytes, B lymphocytes, and the production of IgE. One of the most versatile mAbs in the treatment of various allergic responses is Dupilumab, which is designed to inhibit the signaling chain of IL-3 and IL-4, more specifically, it binds to the α receptor of IL-4 and the cytokine-induced receptor complex IL-13. Dupilumab inhibits IL-4 and IL-13 through receptor 1, stopping the release of IgE and proinflammatory cytokines. This treatment can be used to control the inflammatory response caused by allergens. On the other hand, the use of Dupilumab is not patented as the treatment of choice for allergic pathologies. Therefore, in this review, we compile the results of clinical studies of Dupilumab and other mAbs in atopic dermatitis (AD), eosinophilic esophagitis (EoE), chronic rhinosinusitis with nasal polyps (CRSwNP), and asthma, with the aim of determining which of the mAbs has provided better results.

/pdf/the-role-of-dupilumab-in-diverse-allergic-pathologies-nalzkj81.pdf

The role of dupilumab in diverse allergic pathologies

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Eosinophilic esophagitis: short and long-term considerations.

The role of dupilumab in diverse allergic pathologies