Food‐induced immediate response of the esophagus—A newly identified syndrome in patients with eosinophilic esophagitis

• Published in: Allergy (Copenhagen) Vol. 76; no. 1; pp. 339 - 347
• Main Authors: Biedermann, Luc, Holbreich, Mark, Atkins, Dan, Chehade, Mirna, Dellon, Evan S., Furuta, Glenn T., Hirano, Ikuo, Gonsalves, Nirmala, Greuter, Thomas, Gupta, Sandeep, Katzka, David A., De Rooij, Willemijn, Safroneeva, Ekaterina, Schoepfer, Alain, Schreiner, Philipp, Simon, Dagmar, Simon, Hans Uwe, Warners, Marijn, Bredenoord, Albert‐Jan, Straumann, Alex
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.01.2021
• Subjects: Adult; Allergens; Allergies; Autoimmune diseases; Blood diseases; Burning; clinical symptoms; Cohort Studies; Dysphagia; eosinophilic esophagitis (EoE); Eosinophilic Esophagitis - diagnosis; Eosinophilic Esophagitis - epidemiology; Eosinophilic Esophagitis - etiology; Esophageal diseases; Esophagitis; Esophagus; Food; Food - adverse effects; Food allergies; food‐induced immediate response of the esophagus (FIRE); Gastrointestinal diseases; Humans; immediate response; Leukocytes; Leukocytes (eosinophilic); Male; Middle Aged; oral allergy syndrome; oral allergy syndrome; eosinophilic esophagitis (EoE); food-induced immediate response of the esophagus (FIRE); immediate response; clinical symptoms
• ISSN: 0105-4538; 1398-9995; 1398-9995
• DOI: 10.1111/all.14495

Background Dysphagia is the main symptom of adult eosinophilic esophagitis (EoE). We describe a novel syndrome, referred to as “food‐induced immediate response of the esophagus” (FIRE), observed in EoE patients. Methods Food‐induced immediate response of the esophagus is an unpleasant/painful sensation, unrelated to dysphagia, occurring immediately after esophageal contact with specific foods. Eosinophilic esophagitis experts were surveyed to estimate the prevalence of FIRE, characterize symptoms, and identify food triggers. We also surveyed a large group of EoE patients enrolled in the Swiss EoE Cohort Study for FIRE. Results Response rates were 82% (47/57) for the expert and 65% (239/368) for the patient survey, respectively. Almost, 90% of EoE experts had observed the FIRE symptom complex in their patients. Forty percent of EoE patients reported experiencing FIRE, more commonly in patients who developed EoE symptoms at a younger age (mean age of 46.4 years vs 54.1 years without FIRE; P < .01) and in those with high allergic comorbidity. Food‐induced immediate response of the esophagus symptoms included narrowing, burning, choking, and pressure in the esophagus appearing within 5 minutes of ingesting a provoking food that lasted less than 2 hours. Symptom severity rated a median 7 points on a visual analogue scale from 1 to 10. Fresh fruits/vegetables and wine were the most frequent triggers. Endoscopic food removal was significantly more commonly reported in male patients with vs without FIRE (44.3% vs 27.6%; P = .03). Conclusions Food‐induced immediate response of the esophagus is a novel syndrome frequently reported in EoE patients, characterized by an intense, unpleasant/painful sensation occurring rapidly and reproducibly in 40% of surveyed EoE patients after esophageal contact with specific foods. This study describes food‐induced immediate response of the esophagus (FIRE), a novel syndrome frequently reported in eosinophilic esophagitis (EoE) patients. Eosinophilic esophagitis expert physicians' and patients' surveys were performed to characterize FIRE. A burning and choking unpleasant or painful sensation with rapid occurrence upon ingestion of trigger food is typical of FIRE, occurring in a considerable fraction of EoE patients unrelated from classical solid food dysphagia. Abbreviations: EoE, eosinophilic esophagitis; FIRE, food‐induced immediate response of the esophagus.