Serum immunoglobulin free light chain levels are higher in girls than boys during eosinophilic oesophagitis.

AIM: Eosinophilic oesophagitis (EO) is an emerging worldwide disease, closely associated with male gender and allergic disorders. This study investigated the distribution of allergy markers in a cohort of children with EO. METHODS: We analysed allergy markers in 91 children (62 males and 29 females) with EO and a control group of 45 age-matched children who had non-EO gastrointestinal allergic symptoms. The markers analysed were serum cow's milk-specific and hen's egg-specific IgE, thymic stromal lymphopoietin (TSLP), thymus-regulated and activation-regulated chemokine (TARC/CCL17) and immunoglobulin free light chain (Ig-fLC). RESULTS: In the EO group, cow's milk-specific IgE levels were detectable in 41.9% of males and 62.1% of females and hen's egg-specific levels in 25% of males and 26.9% of females. There was no gender difference in increased TSLP or TARC levels. Kappa Ig-fLC were increased in 5.6% of males and 20.8% of females (p = 0.058) and lambda Ig-fLC in 1.9% of males and 33.3% of females (p = 0.000). No gender differences were found in the control group. CONCLUSION: Our findings suggest that serum TSLP might be a potential marker of EO and TARC of non-EO gastrointestinal food allergies. In EO, serum Ig-fLC appeared higher in females, adding another gender difference to the biology of EO.

The impact of dietary therapy on clinical and biologic parameters of pediatric patients with eosinophilic esophagitis.

BACKGROUND: Eosinophilic esophagitis (EoE) is a clinicopathologic disease that presents with a massive infiltration of the esophagus by eosinophils triggered by food antigen(s). OBJECTIVE: To determine the impact of dietary therapy on nutritional parameters in patients who present with EoE. METHODS: A convenience retrospective study analyzed patients with EoE after a 2-month dietary therapy (6-food elimination diet, avoidance of the 6 most common allergenic foods, plus avoidance of those eliciting positive skin testing, plus amino-acid formula as replacement for dairy products). Pre- and postdiet allergic and nutritional status were evaluated. RESULTS: Of 111 eligible patients, 59 patients, with a median age of 77.7 months (range, 9-189 months) were enrolled. Dietary therapy significantly increased the return to normal endoscopic appearance (47.4%, P < .0009) and led to complete remission (<5 eosinophils/esophageal HPF and disappearance of symptoms) in 59.3%. All symptoms improved, digestive (98.3%), cutaneous (80%), and respiratory (92.8%). The prediet median weight-for-height (WFH) z score was -0.75 (-3.00 to 5.69), and the postdiet WFH did not significantly differ, -0.51 (-3.09 to 5.00). The prediet WFH z score was less than -2 (moderate malnutrition) in 10.1%. Postdiet blood eosinophils counts decreased in absolute numbers and in counts ≥ 500 × 10(6)/L (P < .0001). Evaluation after 1 year of progressive reintroduction of eliminated foods was available in 33 children: the median WFH z score did not significantly improve, from -0.89 (range, -3.00 to 0.67) at enrollment to -0.59 (range, -3.66 to 2.24). CONCLUSION: The nutritional status of children with EoE was mildly affected and not worsened by the 2-month dietary therapy.