Food Allergen Component Sensitization Patterns in Eosinophilic Esophagitis: Insights from a Retrospective Comparative Study

TL;DR

This study compares food allergen sensitization patterns in patients with eosinophilic esophagitis and chronic urticaria, revealing distinct molecular IgE profiles that may reflect dietary exposure rather than immediate allergic reactions.

Contribution

The study identifies unique sensitization patterns to structurally stable food allergen components in EoE patients, not seen in controls, suggesting these may reflect chronic dietary exposure.

Findings

Sensitization to PR-10 proteins was more common in EoE patients compared to chronic urticaria controls.

EoE patients showed sensitization to lipid transfer proteins and plant storage proteins, which were absent in controls.

Component-resolved diagnostics provided descriptive insights but were not useful for directly identifying trigger foods in EoE.

Abstract

Eosinophilic esophagitis (EoE) is a chronic, food-driven inflammatory disorder of the esophagus in which repeated exposure to dietary antigens plays a central role, yet identification of clinically relevant food triggers remains largely empirical. In this retrospective, single-center study, molecular IgE sensitization profiles were descriptively characterized in adult patients with EoE (n = 22) and compared with an allergic control group with chronic urticaria (CU; n = 29) using component-resolved diagnostics. IgE sensitization was common in both cohorts and predominantly reflected inhalant-related, cross-reactive components, particularly PR-10 proteins (63.6% in EoE vs. 37.9% in CU). In contrast, sensitization to structurally stable food allergen components, including lipid transfer proteins and plant storage proteins, was observed in a subset of patients with EoE (31.8%) and was not detected in the control group (0%; p = 0.0015). These food-derived components are characterized by resistance to thermal processing and gastrointestinal digestion and may reflect patterns of sustained dietary exposure rather than acute IgE-mediated reactions. Consistent with previous observations, component-resolved diagnostics showed limited utility for the direct identification of trigger foods in eosinophilic esophagitis. Accordingly, the observed molecular sensitization patterns should be interpreted as descriptive and hypothesis-generating signals rather than as indicators of pathogenic mechanisms or clinical decision-making tools. The findings highlight the importance of considering molecular properties of food allergen components when interpreting sensitization profiles in chronic, non-IgE-mediated inflammatory diseases and underscore the need for prospective studies integrating standardized clinical and dietary outcomes.

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