Challenges with the technical review of eosinophilic esophagitis: discussion points for the practicing allergist

doi:10.1016/j.anai.2020.03.011

Annals of Allergy, Asthma & Immunology

Volume 124, Issue 5, May 2020, Pages 411-413

https://doi.org/10.1016/j.anai.2020.03.011 Get rights and content

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Cited by (2)

Clinical guidance for the use of dupilumab in eosinophilic esophagitis: A yardstick
2023, Annals of Allergy, Asthma and Immunology
The Joint Task Force for the American Academy of Allergy Asthma Immunology and American College of Allergy Asthma Immunology and the American Gastroenterology Association recently published guidelines for the management of eosinophilic esophagitis (EoE). Because the guideline was published, dupilumab became the first and only medication to gain regulatory approval for the treatment of EoE. This expert opinion document provides a framework for how the clinician can consider using dupilumab in the treatment strategy for patients with EoE.
Biologics in eosinophilic gastrointestinal diseases
2023, Annals of Allergy, Asthma and Immunology
Citation Excerpt :
There is 1 Food and Drug Administration (FDA)-approved medication for the treatment of EoE in the United States—dupilumab—and a different medication approved in Europe, Canada, and Australia—swallowed budesonide (Jorveza). The Joint Task Force on Allergy, Asthma and Immunology and American Gastroenterological Association performed a critical review in 2020.4-6 They recommended both dietary elimination and off-label medication use, with corticosteroids having a stronger recommendation owing to randomized, controlled trial-level data which were not yet available for dietary therapies.
Eosinophilic gastrointestinal diseases are a constellation of conditions categorized by the location of eosinophilic infiltration in the gastrointestinal tract. Symptoms vary based on location of eosinophils and age of the patient. There are no approved medications at the current time with individuals using off-label steroids or dietary therapy. Translational research has identified potential pathways to target in the treatment of eosinophilic esophagitis (EoE), gastritis (EoG), and enteritis (EoN), including type 2 pathways, mast cells, and eosinophils. Preliminary studies found cendakimab (anti–interleukin [IL]-13) and dupilumab (anti–IL-4 receptor alpha) to have an effect on eosinophil count and symptoms with dupilumab recently approved. In addition, mepolizumab (anti–IL-5), reslizumab (anti–IL-5), and lirentelimab (anti–Siglec 8) were found to have reduction in eosinophils without reduction of symptoms. For EoG and EoN, both benralizumab (anti–IL-5 receptor) and lirentelimab were found to have histologic and symptom improvement. There are no agents studied for eosinophilic colitis. Results of ongoing phase 3 trials in EoE and EoG/EoN are also anticipated

: Disclosures: Dr Spergel reports being a member of the advisory board and receiving honorarium from DBV Technologies; serving as a consultant and receiving fees from DBV Technologies and Regeneron; serving as a speaker and receiving fees from Abbott; and having contracted research and receiving a grant from Novartis. Dr Aceves reports being a coinventor of oral viscous budesonide, with University California San Diego patent and licensed by Takeda; serving as a consultant for Aimmune, AstraZeneca, and Astellas; and receiving funding from National Institute of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Dr Greenhawt reports being an expert panel and coordinating committee member of the NIAID-sponsored Guidelines for Peanut Allergy Prevention; has served as a consultant for the Canadian Transportation Agency, Thermo Fisher, Intrommune, and Aimmune Therapeutics; is a member of physician/medical advisory boards for Aimmune Therapeutics, DBV Technologies, Sanofi/Genzyme, Genentech, Nutricia, Kaleo Pharmaceutical, Nestle, Aquestive, Allergy Therapeutics, AllerGenis, Aravax, GlaxoSmithKline, Prota, and Monsanto; is a member of the scientific advisory council for the National Peanut Board; has received an honorarium for lectures from Thermo Fisher, Aimmune, DBV, Before Brands, multiple state allergy societies, the American College of Allergy Asthma and Immunology, and the European Academy of Allergy and Clinical Immunology; is an associate editor for the Annals of Allergy, Asthma & Immunology; and is a member of the Joint Task Force on Allergy Practice Parameters.

: Funding: Dr Aceves is funded by NIH R01AI092135, K24AI135034, and R01DK114457. Dr Spergel is funded by Stuart Starr Endowed Chair of Children's Hospital of Philadelphia. Dr Greenhawt is supported by grant #5K08HS024599-02 from the Agency for Healthcare Research and Quality.

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EditorialChallenges with the technical review of eosinophilic esophagitis: discussion points for the practicing allergist

Ann Allergy Asthma Immunol

Gastroenterology

Clin Gastroenterol Hepatol

Editorial
Challenges with the technical review of eosinophilic esophagitis: discussion points for the practicing allergist