# 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.

## Key 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.