EOSINOPHILIC ESOPHAGITIS AS A RARE COMPLICATION OF SUBLINGUAL ALLERGEN-SPECIFIC ALLERGEN IMMUNOTHERAPY. CLINICAL CASE

Abstract

Allergen-specific immunotherapy (ASIT) is the only disease-modifying method of allergy treatment that allows the development of long-term tolerance to an allergen. The therapy is that after confirmation of IgE-dependent sensitization to a particular allergen, the patient can receive treatment with a preparation of this allergen. The most common and effective ASIT for respiratory forms of allergy — rhinitis and bronchial asthma — is allergen therapy with pollen and house dust mite allergens. There is still insufficient data on the effectiveness of animal allergens. For vital indications, ASIT is performed with allergenic venoms of webworms and, in some countries, with food allergens. The duration of therapy is from 3 to 5 years, except for therapy with insect venoms and food allergens, when it is recommended to take the allergen for life to maintain tolerance. Tolerance itself is formed after 4–6 months from the start of treatment and is maintained for years. The safest in terms of anaphylactic reactions is sublingual allergen-specific immunotherapy (SLIT). However, cases of eosinophilic esophagitis (EoE), a rare complication of SLIT, have been described. The present case report describes the development of EoE in a 27-year-old man 4 weeks after starting SLIT with a tablet preparation of meadow grass allergens. The symptoms of EoE resolved rapidly within a few days of SLIT withdrawal. Possible options for continuing ASIT in the development of EoE and specifically in this patient are described.