Development of eosinophilic esophagitis after starting sublingual immunotherapy with cedar pollen extract that improved by a change in administration method: Case report

Abstract

A 41-year-old female underwent upper gastrointestinal endoscopic examination as part of an annual medical check-up, which revealed whitish exudates in the lower esophagus. Biopsy samples subsequently obtained from the esophageal mucosa showed 78 eosinophils per high power field. The patient was diagnosed with eosinophilic esophagitis (EoE). Sublingual immunotherapy (SLIT) with cedar pollen extract for allergic rhinitis had been initiated 15 days prior to the endoscopic examination and she routinely swallowed the liquid medicine after intake. Following the diagnosis of EoE, the patient continued the sublingual intake, although she spit the liquid medicine out afterwards. Endoscopy was again performed three months later, which showed disappearance of the whitish exudates, and the histological findings were also improved. After 18 months, endoscopy and histological findings showed that EoE had completely disappeared, even though the patient had continued SLIT. She also reported that the symptoms of allergic rhinitis were improving.