Allergic mechanisms of Eosinophilic oesophagitis

Best Pract Res Clin Gastroenterol. 2015 Oct;29(5):709-720. doi: 10.1016/j.bpg.2015.09.012. Epub 2015 Sep 11.


Eosinophilic oesophagitis (EoE) is characterized by oesophageal dysfunction and oesophageal eosinophilia refractory to proton-pump-inhibitor treatment. EoE is a food allergy, as elimination of food trigger(s) abrogates the disease, while trigger reintroduction causes recurrence. The allergic mechanism of EoE involves both IgE and non-IgE processes. There is a break in oral tolerance, the immune mechanism allowing enteric exposure to food and micro-organisms without causing deleterious immune responses. Changes in life-style, alterations in gut flora and use of antibiotics may be increasing disease prevalence. Mouse models of EoE and human studies revealed the role of regulatory T-cells and iNKT-cells in the pathogenesis. Th2-cytokines like IL-4, IL-5 and IL-13, and other cytokines like TGFβ and TSLP are involved, but perhaps no one cytokine is critically important for driving the disease. Control of EoE may require a pharmaceutical approach that blocks more than one target in the Th2-inflammatory pathway.

Keywords: Allergic mechanism; Antigen sensitization; Barrier dysfunction; Eosinophilic oesophagitis; Food allergy; Oral tolerance; Pathogenesis; t-helper lymphocyte type 2 immunity.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Disease Models, Animal
  • Eosinophilic Esophagitis / immunology
  • Eosinophilic Esophagitis / physiopathology*
  • Food Hypersensitivity / immunology
  • Food Hypersensitivity / physiopathology*
  • Humans
  • Immune Tolerance / physiology
  • Immunity / physiology
  • Immunoglobulin E / blood
  • T-Lymphocytes, Helper-Inducer / immunology


  • Immunoglobulin E