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The role of mast cells in eosinophilic esophagitis. (Read 7940 times)
Susan
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The role of mast cells in eosinophilic esophagitis.
07/15/11 at 14:26:17
 
Pediatr Allergy Immunol. 2009 Sep;20(6):512-8. Epub 2008 Aug 4.

The role of mast cells in eosinophilic esophagitis.
Lucendo AJ, Bellón T, Lucendo B.
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Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain. alucendo@vodafone.es

Abstract

Eosinophilic esophagitis (EE) is a chronic inflammatory disease of the esophagus which is characterized by the presence of dense infiltrate of eosinophilic leukocytes restricted to this organ mucosa. Accumulating published evidence suggests a strong role of mast cells in the inflammatory infiltrate in the physiopathology of EE. We have reviewed published articles with relevant information about the presence and possible role of mast cells in EE. Although mast cells have been studied indirectly in EE, reported data allow us to confirm that the number of mast cells infiltrating the esophageal epithelium in adult and child patients with EE is higher with respect to the normal state and in gastroesophageal reflux disease. Mast cells linked to IgE, which are not found in other conditions, have been identified in EE. Despite that fact, an anaphylactic reaction history after exposure to allergens is not common in these patients. Therefore, the mast cells' function in EE could be dependent on T lymphocytes, as suggested by a mast cell gene expression analysis. Bi-directional crosstalk is established between mast cells and eosinophils, hence establishing interesting hypotheses regarding their relationship to EE physiopathology. Mast cells' function as an immune response leader seems to substitute for their effector functions in EE, while at the same time opening new research pathways for consideration of these cells as a therapeutic target in EE. However, the inefficiency of therapies that inhibit mast cell functions while they are effective in other respiratory tract diseases results in the need for specific studies to identify the real function of such complex cells in the physiopathology of EE. There is indirect proof of the role of mast cells in EE, while many doubts exist about their activation mechanism, which does not seem to be IgE-mediated. Specific approach studies are needed to clarify the function of these cells in the physiopathology of EE, which could be a possible therapeutic target.

PMID:
   18681944
   [PubMed - indexed for MEDLINE]
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Susan

Chronic Fatigue Syndrome/ Chronic neurological infections
Diagnosed with Mastocytosis August 2011
 
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jbean
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Re: The role of mast cells in eosinophilic esophagitis.
Reply #1 - 07/19/11 at 10:32:40
 
Thanks for posting Susan!  They just identified this condition in me on my upper endoscopy.  I'll be sure to pass this information along.

Just wondering what can be done about it?

Also, I have read that it can also be related to certain medications.  Just wondering if any of our common masto meds might contribute to the mix.  Is it from the masto, or is it from the meds that some of us might be on? If one is slightly allergic to a component of an oral medication, I wonder if this could play into this mechanism?

Interesting reading.
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NZNancy
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Re: The role of mast cells in eosinophilic esophagitis.
Reply #2 - 07/19/11 at 16:54:22
 
Thank you, Susan. This appears to be different from the other esophageal eosinophilia article also posted today.

These researchers have looked at the communication molecule receptors on the mast cells that are found in with the eosinophils, and believe on that basis that T-cells of some sort are responsible for directing whatever it is that mast cells are doing in this situation. They observe that the mast cells do not seem to be there as "effector cells" (cells that directly affect the tissue), but as immune communication cells instead.

They observe that medicines that are helpful in relieving symptoms when mast cells are active in the respiratory tract are not particularly effective in the  eosinophilic esophagitis setting. They also observe that allergy is not what is causing activation of those mast cells.

So, this is another step along the way of trying to understand what is going on. One comment I could make is that eosinophils release leukotrienes, so the leukotriene inhibitors would probably be more effective than antihistamines or mast cell stabilizers.

Nancy
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Susan
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Re: The role of mast cells in eosinophilic esophagitis.
Reply #3 - 07/20/11 at 10:08:28
 
Hi jbean,

My GI doc thinks I have this, too. I had an endoscopy last Thursday, and am waiting for the biopsy results, but they did find the kind of ring like structures they expect to see with EoE.

What I have read is they use swallowed cortisone. They use the inhaler used for asthma, but you don't use the spacer, so more goes into the throat and mouth.

I've read quite a bit about it. Some think it is caused by delayed allergies to unknown substances, others don't. I'm especially interested, as I think it may be active throughout my entire GI tract.

Nancy, thank you for explaining the study. I do want to say, based on other things I have read, that they are stating that IgE allergy is probably not involved, but that doe snot mean that other allergy reactions are not.

As I said above, some researchers  believe that it may be delayed allergy response, which is not IgE mediated. Some patients have been able to find their triggers, and manage the illness that way.

Unfortunately, it is only managed, not cured. The use of cortisone only helps for as long as it is used, once stopped, symptoms return.
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Susan

Chronic Fatigue Syndrome/ Chronic neurological infections
Diagnosed with Mastocytosis August 2011
 
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