Published Online: June 19, 2015
Although many patients with eosinophilic esophagitis (EoE) improve after they remove foods with cow’s milk and/or wheat from their diet, it has not been clear whether the results of skin prick allergy tests can be used to predict an individual patient’s response to diet.
In a recently published study in The Journal of Allergy and Clinical Immunology: In Practice, Erwin and colleagues’ goal was to examine IgE antibody responses to foods that appear to play a role in EoE. Forty-six adults and 51 children with EoE had allergy skin prick testing and laboratory testing for IgE specific for environmental allergens, whole food extracts, and the specific proteins (or components) that are recognized as allergens in cow’s milk.
In adults and children, it was more common to see a positive laboratory test showing IgE antibodies to food than a positive skin prick test. Cow’s milk specific IgE was detectable in 47% of the patients in the study. However, in keeping with other studies, the titers of IgE antibodies to milk were consistently low (mean 1.2 IU/mL). There was a strong relationship between specific IgE antibodies to whey milk proteins Bos d 4 (α-lactalbumin) or Bos d 5 (β-lactoglobulin) and milk extract specific IgE (R=0.89 and R=0.76 respectively; p<0.001).
Interestingly, the evidence from the authors’ dietary studies and other studies suggests that IgE is not the primary mechanism for the inflammation in EoE. Nonetheless, the component studies on milk proteins may identify proteins that are relevant. More studies are needed to evaluate the clinical relevance of these findings.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.