Eosinophilic Esophagitis during Milk Oral Immunotherapy in a Child with Severe IgE-Mediated CMPA: A Case Report
Sara Moujtahid *
Department of Pediatric Gastroenterology and Hepatology, Children's Hospital of Rabat, Ibn Sina University Hospital of Rabat, Morocco.
Said Ettair
Department of Pediatric Gastroenterology and Hepatology, Children's Hospital of Rabat, Ibn Sina University Hospital of Rabat, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Background: Oral immunotherapy (OIT) for persistent cow’s milk protein allergy (CMPA) can improve protection against accidental exposures, but gastrointestinal adverse events, including eosinophilic esophagitis (EoE), are increasingly recognized.
Case: A 4.5-year-old boy with severe IgE-mediated CMPA and atopy began milk OIT. After 6 weeks he developed odynophagia, dysphagia, vomiting, anorexia, and weight stagnation.
Diagnosis & Treatment: Upper endoscopy showed EoE with peak 78 eosinophils/high-power field (eos/HPF). A strict milk-free diet, proton-pump inhibitor, and swallowed topical budesonide were initiated.
Outcome: Symptoms resolved with weight catch-up; follow-up biopsies at 3 months showed remission (3 eos/HPF).
Conclusion: In high-risk, highly atopic children, OIT warrants close clinical and endoscopic monitoring. When EoE is suspected, guideline-based evaluation (EREFS, ≥6 biopsies from ≥2 levels) and early anti-inflammatory therapy are recommended.
Keywords: Cow’s milk protein allergy, oral immunotherapy, eosinophilic esophagitis, child, atopy