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Outcomes of serum food-specific immunoglobulin G₄ to guide elimination diet in patients with eosinophilic esophagitis

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dc.contributor.authorLim, A.H.W.
dc.contributor.authorNgoi, B.
dc.contributor.authorPerkins, G.B.
dc.contributor.authorWong, S.
dc.contributor.authorWhitelock, G.
dc.contributor.authorHurtado, P.
dc.contributor.authorRuszkiewicz, A.
dc.contributor.authorLe, T.T.A.
dc.contributor.authorHissaria, P.
dc.contributor.authorNguyen, N.Q.
dc.date.issued2024
dc.description.abstractIntroduction: Eosinophilic esophagitis (EoE) is associated with atopy; however, recent studies have identified an association with food-specific immunoglobulin G₄ (FS-IgG₄) rather than immunoglobulin E antibodies. This study aimed to evaluate the role of serum FS-IgG₄ in guiding an elimination diet and its outcomes. Methods: Patients with and without EoE were enrolled in a prospective, controlled, single tertiary center trial. Serum FS-IgG₄ titers, esophageal eosinophil counts, and dysphagia symptom questionnaire scores were assessed, and participants with elevated FS-IgG₄ (ImmunoCAP, cutoff of 10 mgA/L) commenced 6-week targeted elimination diet. Repeat serum FS-IgG₄ and endoscopic and histologic examination were performed at 6-week follow-up. Results: Twenty-two patients with active EoE and 13 controls were recruited. Serum FS-IgG₄ to milk, wheat, soy, eggs, and nuts was significantly higher in EoE (P = 0.0002, P = 0.002, P = 0.003, P = 0.012, and P < 0.001, respectively). Elevated serum FS-IgG₄ to 1 or more food groups (median 2) was identified in 21/22 (95.4%) patients with EoE; 20/21 underwent 6-week dietary elimination. Median reductions in dysphagia symptom questionnaire score and EoE endoscopic reference score after elimination were 8 (P = 0.0007) and 1 (P = 0.002), respectively. Nine (45%) patients had histological remission (<15 eosinophils per high-power field). Fall in median esophageal eosinophil count was not statistically significant (50 vs 23; P = 0.068). Serum FS-IgG₄ did not decline by 6-week follow-up. Discussion: Serum FS-IgG₄ to milk, wheat, soy, egg, and nuts was present at higher levels in EoE, with targeted elimination resulting in 45% histologic remission rate. Serum FS-IgG₄ has potential as a noninvasive biomarker in EoE. When successful, FS-IgG₄–led elimination diet can negate need for medications and be viewed more favorably by patients because of its smaller endoscopic burden compared with empirical elimination diets.
dc.identifier.citationAmerican Journal of Gastroenterology, 2024; 119(6):1066-1073
dc.identifier.doi10.14309/ajg.0000000000002678
dc.identifier.issn0002-9270
dc.identifier.issn1572-0241
dc.identifier.orcidLim, A.H.W. [0000-0001-8172-9140]
dc.identifier.orcidPerkins, G.B. [0000-0001-8559-5872]
dc.identifier.orcidHurtado, P. [0000-0002-0913-7797]
dc.identifier.orcidRuszkiewicz, A. [0000-0001-9052-4948]
dc.identifier.orcidLe, T.T.A. [0000-0001-8205-865X]
dc.identifier.orcidNguyen, N.Q. [0000-0002-1270-5441]
dc.identifier.urihttps://hdl.handle.net/11541.2/39126
dc.language.isoen
dc.publisherWolters Kluwer Health
dc.rightsCopyright 2024 The American College of Gastroenterology
dc.source.urihttps://doi.org/10.14309/ajg.0000000000002678
dc.subjecteosinophilic esophagitis
dc.subjectfood-specific IgG₄
dc.subjectIgG₄
dc.subjecttargeted elimination diet
dc.titleOutcomes of serum food-specific immunoglobulin G₄ to guide elimination diet in patients with eosinophilic esophagitis
dc.typeJournal article
pubs.publication-statusPublished
ror.mmsid9916866024901831

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