Long-term remission in a patient with eosinophilic colitis (EC) after detection of local food antigen-specific IgE and subsequent allergen avoidance

Introduction Eosinophilic gastrointestinal disorders (EGIDs) are a heterogeneous group of rare conditions, characterized by eosinophilic infiltration (EoIn) of the gastrointestinal mucosa, rarely the muscularis or tunica serosa, in connection with GI-symptoms. Other causes of EoIn must be excluded before EGID is diagnosed. EGIDs present as eosinophilic gastritis, eosinophilic gastroenteritis and EC. An immune pathogenesis seems to be involved, but the causal triggers are unknown.

Methods Here we report an a 48yr old male suffering from chronic diarrhea and recurrent IBS symptomatology (IBS-S 266). Comprehensive serological and differential diagnostic tests could not reveal the cause of the diarrhea. Histology of the lower GIT showed an unspecific colitis and increased EoIn-score, but no explanation for the EC could be found. Thus, an endoscopically controlled segmental intestinal lavage was performed to search for local IgE antibodies.

Results Lavage fluid show elevated levels of eosinophilic cationic protein and increased specific IgE towards wheat, corn, and borderline IgE-titers towards nuts, pork and beef, while cutaneous or serological test were inconclusive. Subsequent allergen avoidance and antiallergic treatment resulted in complete clinical and histological remission of EC (IBS-S 46). After two years follow-up the patient was free of diarrhea, no significant IgE titers were detected and tissue eosinophilia was absent.

Discussion Although the exact triggers for EC are yet unknown, this case illustrates that local food-IgE may be related to the manifestation of an EGID. Local eosinophil activation, IgE-antibodies and clinical symptoms were reduced after specific allergen avoidance. Thus, intense efforts should be made to clarify potential triggers for EC like drugs, salizylate hypersensitivity, but also food antigens. This case shows that the EC diagnosed initially should be re-classified as a local seronegative GI-allergy, as a possible secondary cause for an EGID.

Publication History

Article published online:
07 September 2021