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Pina-Trincão D.1, Paiva M.1, Finelli E.1, Afonso I.2, Cabral J.2, Leiria-Pinto P.1

1 - Dona Estefânia Hospital, CHLC - EPE, Immunoallergology Department, Lisboa
2 - DonaEstefânia Hospital, CHLC - EPE, Pediatric Gastroenterology Unit, Lisbon, Portugal

EAACI Congress 2016 · Abstract: A-716-0048-01656 · Status: Draft

Introduction: Eosinophilic esophagitis (EoE) is an antigen-mediated disease of the esophagus frequently diagnosed in childhood. The diagnosis of EoE depends on the exclusion of other causesof esophageal eosinophillia, namely gastroesophageal reflux disease (GERD) and the most recently described PPI-responsive esophageal eosinophillia (PPI-REE). We present 3 pediatric cases of EoE diagnosed (with normal 24 hour esophageal pHmetry) according to the 2007 consensus, before PPI-REE had been recognized as a new differential diagnosis.
Case 1: 18 months old infant referred to our hospital with failure to thrive. As well as EoE, he also presented IgE sensitization to egg. Egg avoidance and PPI were started with clinical and histological remission. At 3 years old, while on an egg-free diet, EoE relapsed, ensuing therapeutic switch to topical fluticasone (500 mcg bid), achieving remission. At 6 years old, after a new relapse, treatment with lansoprazol 30 mg bid was started, achieving clinical and histological resolution.
Case 2: A 2 year old boy was referred due to recurrent vomiting. Diagnosis of EoE was made and remission was achieved with topical fluticasone, after combined egg avoidance and standard PPI had failed. A new relapse was diagnosed at 8 years old. Treatment with esomeprazol 20mg bid was initiated, achieving remission.
Case 3: A 15 month old boy with a past history of corrected esophageal atresia was referred with diagnosis of EoE after complaints of food impaction. Skin Prick Tests were positive for egg white and yolk. Inital treatment with egg avoidance and PPI was initiated without improvement. Topical fluticasone achieved clinical and histological resolution. Relapsing disease was diagnosed at 5.
Clinical and histological remission was achieved after a trial with esomeprazol 20 mg bid. The three patients still remain asymptomatic under PPI treatment. 
Discussion: PPI-REE is an emerging cause of esophageal eosinophilia. A treatment regimen with a high dose PPI, despite normal pHmetry, is mandatory to confirm this diagnosis and rule out EoE. As described recently in adults, in this small pediatric series clinical and histological remission of esophageal eosinophilia was achieved in the same patient, whether with high dose PPI or the usual treatment for EoE (diet or fluticasone). It sounds plausible we may be not talking about different diseases, but only different manifestations of a pathology with a wide spectrum of presentation range.

Palavras-chave: Alergia ao leite de vaca, alergia ao ovo, leite de vaca cozinhado, ovo cozinhado, alergenicidade,processamento térmico.