Eosinophilic esophagitis is characterized by a non-IgE-mediated food hypersensitivity

Allergy. 2016 May;71(5):611-20. doi: 10.1111/all.12846. Epub 2016 Feb 25.


Eosinophilic esophagitis (EoE) is a chronic disease characterized clinically by symptoms of esophageal dysfunction and histologically by eosinophil-predominant inflammation. EoE is frequently associated with concomitant atopic diseases and immunoglobulin E (IgE) sensitization to food allergens in children as well as to aeroallergens and cross-reactive plant allergen components in adults. Patients with EoE respond well to elemental and empirical food elimination diets. Recent research has, however, indicated that the pathogenesis of EoE is distinct from IgE-mediated food allergy. In this review, we discuss the individual roles of epithelial barrier defects, dysregulated innate and adaptive immune responses, and of microbiota in the pathogenesis of EoE. Although food has been recognized as a trigger factor of EoE, the mechanism by which it initiates or facilitates eosinophilic inflammation appears to be largely independent of IgE and needs to be further investigated. Understanding the pathogenic role of food in EoE is a prerequisite for the development of specific diagnostic tools and targeted therapeutic procedures.

Keywords: eosinophilic esophagitis; epithelial barrier; food allergy; immune response; immunoglobulin E.

Publication types

  • Review

MeSH terms

  • Allergens / immunology
  • Anti-Asthmatic Agents / therapeutic use
  • Eosinophilic Esophagitis / diagnosis*
  • Eosinophilic Esophagitis / drug therapy
  • Eosinophilic Esophagitis / etiology*
  • Eosinophilic Esophagitis / metabolism
  • Epithelium / immunology
  • Epithelium / metabolism
  • Epithelium / pathology
  • Food / adverse effects
  • Food Hypersensitivity / diagnosis*
  • Food Hypersensitivity / etiology*
  • Food Hypersensitivity / metabolism
  • Humans
  • Hypersensitivity / immunology
  • Hypersensitivity / metabolism
  • Hypersensitivity / pathology
  • Immunity, Innate
  • Immunoglobulin E / immunology
  • Inflammatory Bowel Diseases / diagnosis
  • Inflammatory Bowel Diseases / etiology
  • Inflammatory Bowel Diseases / metabolism
  • Omalizumab / therapeutic use
  • Skin / immunology
  • Skin / metabolism
  • Skin / pathology
  • Th2 Cells / immunology
  • Th2 Cells / metabolism
  • Treatment Outcome


  • Allergens
  • Anti-Asthmatic Agents
  • Omalizumab
  • Immunoglobulin E