EoE Food Desensitization
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Mücərrəd
Təsvir
Eosinophilic esophagitis (EoE) is a clinicopathologic disorder of the esophagus triggered by food and/or environmental allergens and is characterized by symptoms of esophageal dysfunction and eosinophilia of the esophagus. Current therapy is centered on controlling inflammation with steroids and/or food antigen avoidance. Such treatment options have significant side effects and reduce quality of life, especially in children. The purpose of the study is to discover a way for flare-provoking foods to be reintroduced into the child's diet without the need for medical therapy.
The study would involve children ages 3-17 years with biopsy-proven EoE who have a known flare-inducing food trigger. Following baseline blood work and esophagogastroduodenoscopy (EGD), the investigators will initiate oral desensitization treatment in which the child swallows a spray solution containing his or her specific food allergen extract in increasing concentrations twice daily for 4 months. The next phase of the study would involve reintroduction of the actual food for 4 weeks followed by repeat blood work and EGD. Success would be defined by having a peak eosinophil count <15 per high power field on the final esophageal biopsy.
Oral food desensitization has been well-studied in patients with food allergies but never in patients with pre-existing EoE. In those studies, the adverse events included mild reactions, such as watery eyes, rhinitis, sneezing, throat pruritus, transient erythema and abdominal pain. These reactions usually did not require stopping desensitization and were well controlled by antihistamines and steroids. Benefits include children having a less restricted diet and eliminating the need for steroid therapy. This study should yield valuable information regarding the management of EoE, thereby improving the current understanding of its pathogenesis.
Tarixlər
| Son Doğrulandı: | 10/31/2019 |
| İlk təqdim: | 08/10/2016 |
| Təxmini qeydiyyat təqdim edildi: | 08/22/2016 |
| İlk Göndərmə: | 08/28/2016 |
| Son Yeniləmə Göndərildi: | 11/05/2019 |
| Son Yeniləmə Göndərildi: | 11/07/2019 |
| Həqiqi Təhsilin Başlama Tarixi: | 08/07/2018 |
| Təxmini İlkin Tamamlanma Tarixi: | 04/30/2020 |
| Təxmini İşin Tamamlanma Tarixi: | 04/30/2020 |
Vəziyyət və ya xəstəlik
Müdaxilə / müalicə
Other: Oral food desensitization
Faza
Qol Qrupları
| Qol | Müdaxilə / müalicə |
|---|---|
| Experimental: Oral food desensitization All of the children enrolled in the study will receive oral food desensitization with his or her specific EoE flare-inducing food antigen (e.g. cow's milk protein). The food antigen will be diluted in a 50% glycerin/water solution containing ascorbic acid (Vitamin C) to stabilize and preserve the solution. This oral spray will need to be administered twice a day, every day for a total of 4 months. | Other: Oral food desensitization The child's specific food antigen will be diluted in a 50% glycerin/water solution containing ascorbic acid (Vitamin C). This oral spray solution will need to be administered twice a day, every day for a total of 4 months |
Uyğunluq Kriteriyaları
| Təhsil üçün uyğun yaşlar | 3 Years Üçün 3 Years |
| Təhsilə Uyğun Cinslər | All |
| Sağlam Könüllüləri qəbul edir | Bəli |
| Kriteriyalar | Inclusion Criteria: 1. Pediatric patient, ages 3-17 years, with known diagnosis of EoE based upon esophageal biopsy demonstrating ≥15 eos/hpf and lack of symptomatic or histological response to PPI therapy and/or normal esophageal pH evaluation. 2. Known or suspected flare-inducing food trigger based upon supporting histological evidence. 3. Already undergoing a baseline EGD followed by food reintroduction and repeat EGD, as standard of care at the recommendation of the child's gastroenterologist. 4. Signed informed consent for the subject's participation in the study provided by the parent/ legal guardian and child/adolescent assent for subjects 7-17 years. 5. Assent by the patient's pediatric gastroenterologist for the patient's participation in the study. Exclusion Criteria: 1. Presence of other disorders associated with similar clinical, histological or endoscopic features, such as PPI-responsive esophageal eosinophilia, esophageal eosinophilia associated with gastroesophageal reflux disease (GERD), Crohn's disease, infectious esophagitis (i.e. herpes simplex virus or candida), drug-associated esophagitis, collagen vascular disease, hypereosinophilic syndrome and eosinophilic gastroenteritis. 2. Previous or current diagnosis of cancer or leukemia. 3. History of chemotherapy within the past 3 months. 4. History of esophageal stricture or food impaction. 5. History of anaphylaxis or other severe adverse reaction to the specific food trigger being tested. |
Nəticə
İlkin nəticə tədbirləri
1. Peak eosinophil count on esophageal biopsy [5 months]
