case_images: PMC11004767_01
case_images: Assessment of clinical and serological response to dupilumab. A: Eosinophilic Esophagitis Activity Index (EEsAI), Asthma Control Test (ACT), and food-induced immediate response of the esophagus (FIRE) episodes were measured up to 24 weeks after initiation of dupilumab. Laboratory tests were performed 8 and 24 weeks after first dose of dupilumab. B: Hematoxylin and eosin staining of esophagus biopsies obtained during gastroscopies before (left) and 10 weeks after (right) treatment with dupilumab. Arrows indicate eosinophils in esophageal mucosa.
case_images: allergologieselect-8-078-01.jpg
case_images: PMC11004767_01_allergologieselect-8-078-01.jpg
case_images: Figure1
case_images: Eosinophilic Esophagitis Activity Index (EEsAI) of 62/100 and esophageal Candidiasis requiring amphotericin B lozenges (Figure 1A). EoE led to avoidance behaviors of eating in restaurants and dieting with consecutive weight loss. The patient reported ~ 2 - 3 FIRE episodes per week with a wide variety of foods, especially corn (Figure 1A). The patient showed exacerbations of AA and AR during cold wet weather, and his AA was not controlled during his first visit with an Asthma Control Test (ACT) of 11/24 (Figure 1A).  Complete blood count (CBC) revealed blood eosinophilia of 7.3% and 0.55 gpt/L (normal range < 0.5 gpt/L), and laboratory tests showed elevated eosinophil cationic protein (ECP) of 23.3 microg/L (< 13 microg/L) and elevated total IgE of 1,327 kU/L (< 114 kU/L) (Figure 1A). Alternaria), as well as food allergens (peanut, egg-white) without previous anaphylactic reactions (Table 1). A gastroscopy had shown the onset of esophageal sparing and histologic accumulation of eosinophils in the mucosa (> 20 eosinophils/HPF), indicative of EoE (Figure 1B).  During therapy, weekly disease activity scores (EEsAI and ACT) and laboratory controls documented rapid clinical improvement (Figure 1A).  After just 2 weeks, the patient showed a clear response in the activity scores, which increasingly improved to their maximal value after 4 weeks and remained stable over the next 32 weeks (Figure 1A). FIRE-causing products (e.g., corn) could be eaten without problems, and FIRE episodes were completely absent 4 weeks after dupilumab initiation (Figure 1A). Furthermore, the patient presented an ACT of 24/24 (complete control) (Figure 1A). Noteworthy was a reduction of eosinophils to normal range after 8 weeks, a reduction of ECP, and a strong reduction of total IgE after 24 weeks, which is consistent with previous reports (Figure 1A). Control gastroscopy after 10 weeks of treatment showed no evidence of EoE, and histologically no accumulations of eosinophils were detectable (Figure 1C).