Eosinophilic esophagitis laboratory findings: Difference between revisions
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{{Eosinophilic esophagitis}} | {{Eosinophilic esophagitis}} | ||
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==Overview== | ==Overview== | ||
There are no specific diagnostic markers to diagnose the EoE patients. Although not specific, elevated serum IgE level is identified in the majority of patients as well as increased peripheral eosinophil count. There are 3 main ways in which food allergies can be detected in EoE: skin prick testing, blood allergy testing, atopy patch testing. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
*Laboratory findings of the EoE are as follows:<ref name="pmid18304887">{{cite journal |vauthors=Roy-Ghanta S, Larosa DF, Katzka DA |title=Atopic characteristics of adult patients with eosinophilic esophagitis |journal=Clin. Gastroenterol. Hepatol. |volume=6 |issue=5 |pages=531–5 |year=2008 |pmid=18304887 |doi=10.1016/j.cgh.2007.12.045 |url=}}</ref><ref name="pmid20568382">{{cite journal |vauthors=Erwin EA, James HR, Gutekunst HM, Russo JM, Kelleher KJ, Platts-Mills TA |title=Serum IgE measurement and detection of food allergy in pediatric patients with eosinophilic esophagitis |journal=Ann. Allergy Asthma Immunol. |volume=104 |issue=6 |pages=496–502 |year=2010 |pmid=20568382 |doi=10.1016/j.anai.2010.03.018 |url=}}</ref><ref name="pmid19733260">{{cite journal |vauthors=Dellon ES, Gibbs WB, Fritchie KJ, Rubinas TC, Wilson LA, Woosley JT, Shaheen NJ |title=Clinical, endoscopic, and histologic findings distinguish eosinophilic esophagitis from gastroesophageal reflux disease |journal=Clin. Gastroenterol. Hepatol. |volume=7 |issue=12 |pages=1305–13; quiz 1261 |year=2009 |pmid=19733260 |doi=10.1016/j.cgh.2009.08.030 |url=}}</ref><ref name="pmid18061100">{{cite journal |vauthors=Chehade M, Sampson HA |title=Epidemiology and etiology of eosinophilic esophagitis |journal=Gastrointest. Endosc. Clin. N. Am. |volume=18 |issue=1 |pages=33–44; viii |year=2008 |pmid=18061100 |doi=10.1016/j.giec.2007.09.002 |url=}}</ref><ref name="pmid17617209">{{cite journal |vauthors=Dellon ES, Aderoju A, Woosley JT, Sandler RS, Shaheen NJ |title=Variability in diagnostic criteria for eosinophilic esophagitis: a systematic review |journal=Am. J. Gastroenterol. |volume=102 |issue=10 |pages=2300–13 |year=2007 |pmid=17617209 |doi=10.1111/j.1572-0241.2007.01396.x |url=}}</ref><ref name="pmid17426462">{{cite journal |vauthors=Aceves SS, Newbury RO, Dohil R, Schwimmer J, Bastian JF |title=Distinguishing eosinophilic esophagitis in pediatric patients: clinical, endoscopic, and histologic features of an emerging disorder |journal=J. Clin. Gastroenterol. |volume=41 |issue=3 |pages=252–6 |year=2007 |pmid=17426462 |doi=10.1097/01.mcg.0000212639.52359.f1 |url=}}</ref> | |||
*There are no specific diagnostic markers to diagnose EoE patients. | |||
*Although not specific, elevated serum IgE level is identified in majority patients. | |||
*Increased peripheral eosinophil count is also seen in the majority of patients. | |||
There are 3 main ways in which food allergies can be detected in EoE are as follows | |||
'''Skin prick testing''' | |||
* A small amount of allergen is introduced into the skin of the patient through a gentle puncture with a pricking device. | |||
* Patients who are sensitive to the allergen have immunoglobulin E (IgE), which causes type-1 hypersensitivity reaction and cause an area of redness and swelling around the prick. | |||
* The entire procedure takes 15 min, however, these tests may have limited use in identifying foods causing or precipitating EoE. | |||
'''Blood allergy testing''' | |||
* Serum specific immune assay can be done for the allergen testing especially in patients with food allergies. | |||
* Although there are many limitations for the prick testing and the blood testing for the allergy in patients with EoE, prick testing is considered more efficient in EoE. | |||
'''Atopy patch testing''' | |||
* Atopy patch testing is another way of identifying the allergies in patients with EoE. | |||
* This is more useful in the pediatric population than in the adults. | |||
The results from the food patch test helps the physician to determine which foods can be avoided | * Patch testing is used to identify patients with delayed reactions to a food. | ||
** '''Procedure:''' A small amount of a fresh food in a small aluminum chamber called a Finn chamber. | |||
** The Finn chamber is then taped on the person’s back. | |||
** The food in the chamber stays in contact with the skin for 48 hours. | |||
** It is then removed and the allergist reads the results at 72 hours. | |||
** A positive delayed reaction to the food is determined by the inflamed area of the skin around the Finn chamber. | |||
** The results from the food patch test helps the physician to determine which foods can be avoided | |||
All the above-mentioned tests can have false positive tests, it is also possible to have a false negative test, meaning that the prick, blood or patch tests are negative yet the allergen can contribute towards a patient’s EoE. | * All the above-mentioned tests can have false positive tests, it is also possible to have a false negative test, meaning that the prick, blood or patch tests are negative yet the allergen can contribute towards a patient’s EoE. | ||
==References== | ==References== | ||
Latest revision as of 14:50, 29 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ajay Gade MD[2]]
Overview
There are no specific diagnostic markers to diagnose the EoE patients. Although not specific, elevated serum IgE level is identified in the majority of patients as well as increased peripheral eosinophil count. There are 3 main ways in which food allergies can be detected in EoE: skin prick testing, blood allergy testing, atopy patch testing.
Laboratory Findings
- Laboratory findings of the EoE are as follows:[1][2][3][4][5][6]
- There are no specific diagnostic markers to diagnose EoE patients.
- Although not specific, elevated serum IgE level is identified in majority patients.
- Increased peripheral eosinophil count is also seen in the majority of patients.
There are 3 main ways in which food allergies can be detected in EoE are as follows
Skin prick testing
- A small amount of allergen is introduced into the skin of the patient through a gentle puncture with a pricking device.
- Patients who are sensitive to the allergen have immunoglobulin E (IgE), which causes type-1 hypersensitivity reaction and cause an area of redness and swelling around the prick.
- The entire procedure takes 15 min, however, these tests may have limited use in identifying foods causing or precipitating EoE.
Blood allergy testing
- Serum specific immune assay can be done for the allergen testing especially in patients with food allergies.
- Although there are many limitations for the prick testing and the blood testing for the allergy in patients with EoE, prick testing is considered more efficient in EoE.
Atopy patch testing
- Atopy patch testing is another way of identifying the allergies in patients with EoE.
- This is more useful in the pediatric population than in the adults.
- Patch testing is used to identify patients with delayed reactions to a food.
- Procedure: A small amount of a fresh food in a small aluminum chamber called a Finn chamber.
- The Finn chamber is then taped on the person’s back.
- The food in the chamber stays in contact with the skin for 48 hours.
- It is then removed and the allergist reads the results at 72 hours.
- A positive delayed reaction to the food is determined by the inflamed area of the skin around the Finn chamber.
- The results from the food patch test helps the physician to determine which foods can be avoided
- All the above-mentioned tests can have false positive tests, it is also possible to have a false negative test, meaning that the prick, blood or patch tests are negative yet the allergen can contribute towards a patient’s EoE.
References
- ↑ Roy-Ghanta S, Larosa DF, Katzka DA (2008). "Atopic characteristics of adult patients with eosinophilic esophagitis". Clin. Gastroenterol. Hepatol. 6 (5): 531–5. doi:10.1016/j.cgh.2007.12.045. PMID 18304887.
- ↑ Erwin EA, James HR, Gutekunst HM, Russo JM, Kelleher KJ, Platts-Mills TA (2010). "Serum IgE measurement and detection of food allergy in pediatric patients with eosinophilic esophagitis". Ann. Allergy Asthma Immunol. 104 (6): 496–502. doi:10.1016/j.anai.2010.03.018. PMID 20568382.
- ↑ Dellon ES, Gibbs WB, Fritchie KJ, Rubinas TC, Wilson LA, Woosley JT, Shaheen NJ (2009). "Clinical, endoscopic, and histologic findings distinguish eosinophilic esophagitis from gastroesophageal reflux disease". Clin. Gastroenterol. Hepatol. 7 (12): 1305–13, quiz 1261. doi:10.1016/j.cgh.2009.08.030. PMID 19733260.
- ↑ Chehade M, Sampson HA (2008). "Epidemiology and etiology of eosinophilic esophagitis". Gastrointest. Endosc. Clin. N. Am. 18 (1): 33–44, viii. doi:10.1016/j.giec.2007.09.002. PMID 18061100.
- ↑ Dellon ES, Aderoju A, Woosley JT, Sandler RS, Shaheen NJ (2007). "Variability in diagnostic criteria for eosinophilic esophagitis: a systematic review". Am. J. Gastroenterol. 102 (10): 2300–13. doi:10.1111/j.1572-0241.2007.01396.x. PMID 17617209.
- ↑ Aceves SS, Newbury RO, Dohil R, Schwimmer J, Bastian JF (2007). "Distinguishing eosinophilic esophagitis in pediatric patients: clinical, endoscopic, and histologic features of an emerging disorder". J. Clin. Gastroenterol. 41 (3): 252–6. doi:10.1097/01.mcg.0000212639.52359.f1. PMID 17426462.