Eosinophilic oesophagitis during oral immunotherapy for peanut allergy
Eosinophilic oesophagitis during oral immunotherapy for peanut allergy
A current PV case report is a reminder to Swissmedic that eosinophilic oesophagitis is a potential adverse drug reaction to oral immunotherapy for peanut allergy.
Eosinophilic oesophagitis (EoE) is a chronic, immune-mediated inflammation of the oesophagus characterised by an accumulation of eosinophilic granulocytes in the mucosa. The main clinical features of this disease are difficulty swallowing (dysphagia) and a feeling of something in the throat (globus). It is typically diagnosed by oesophago-gastroscopy and a biopsy.
The primary treatment options are proton pump inhibitors, corticosteroids and dietary changes. Left untreated, EoE can lead to fibrosis of the oesophagus, which increases the risk of strictures and associated complications. While the exact pathophysiology of EoE is not fully understood, risk factors include a genetic predisposition (familial clustering, more frequent occurrence in men), pre-existing allergies (most of those affected already suffer from allergies such as asthma, hay fever or food allergies), and external allergens such as pollen [1,2].
Palforzia, eosinophilic oesophagitis, eoe, eosinophilic granulocytes, difficulty swallowing, peanut allergy, allergy
Incident data |
Description |
Case: 2024 Age group: Children (< 12 years) Sex: unknown Medicinal product: Palforzia® Active substance: Peanut allergens (Arachis hypogaea) Indication: Peanut allergy ADR: eosinophilic oesophagitis Outcome: recovered |
During the dose-increasing phase, the patient developed difficulty swallowing, pain behind the sternum and postprandial dyspnoea. The diagnosis of eosinophilic oesophagitis was confirmed histologically. The treatment with Palforzia® was discontinued. The patient was treated with oral steroids and recovered within two months. |
Summary and recommendation
Palforzia® is used as specific oral immunotherapy in children and adolescents aged 4 to 17 years who have been diagnosed with a clinically relevant peanut allergy.
Eosinophilic oesophagitis is an uncommon and potentially serious adverse drug reaction associated with oral immunotherapy with Palforzia®. In patients with severe or persistent gastrointestinal symptoms such as dysphagia, gastroesophageal reflux, chest pain or abdominal pain, Palforzia must be discontinued and the diagnosis of eosinophilic oesophagitis considered. Investigation by oesophago-gastroscopy is recommended. Eosinophilic oesophagitis is also a known possible side effect of oral immunotherapy with Grazax (Phleum pratense) or Itulazax (Betula verrucosa) [3].
Statutory duty of healthcare professionals to report adverse drug reactions (ADRs)
In Switzerland, healthcare professionals who are authorised to dispense or administer medicinal products are obligated to report severe and/or previously unknown side effects. Reports to Swissmedic can be entered and sent in the Electronic Vigilance Reporting Portal “ElViS” (ElViS login).
