A recent double-blind pilot study (n=20) (JM Spegel et al. Clin Gastroenterol Hepatol 2020; 18: 328-36) explored the use of epicutaneous immunotherapy (EPIT) in children with milk-induced eosinophilic esophagitis (EoE). 15 children received active treatment with a “Viaskin” milk allergen extract patch and 5 children received a placebo.
The premise of EPIT for EoE has been based on animal models (mouse & piglet) which have shown that epicutaneous desensitization to peanuts has been successful in preventing development of EoE.
The design of the study involved EPIT during a 9 month milk-free period followed by a milk-containing diet for 2 months. Biopsies were taken and then there was an additional 11 month open-label phase in which all patients received EPIT.
- No significant differences in mean eos/hpf in the two groups: 50 vs 48 in EPIT compared to placebo respectively.
- There were 9 of 19 (47%) had a significant drop in eosinophil count with less than 15 eos/hpf at the end of the open-label phase.
- Overall, adverse events were similar in both groups, though the EPIT group had more frequent GI adverse events than the placebo group (67% vs. 40%)
My take: The primary and secondary endpoints were not reached in this study. However, based on the open-label phase response, further studies are warranted.
Related blog posts:
- New Therapy for Eosinophilic Esophagitis
- Grading Treatment Response in EoE
- Promising Biologic for Eosinophilic Esophagitis
- Transnasal Endoscopy (Unsedated) for EoE
- How Genetics Influence Response Rate to PPIs in EoE
- Association and Causation: Early Life Risk Factors for Eosinophilic Esophagitis
- Negligible Effect of Eosinophilic Esophagitis Treatment on Longitudinal Growth
- Increased Risk of EoE with TEF/EA
- What is EoE?
- EoE Update 2018 (Dr. Seth Marcus)
- Updated Consensus Guidelines for Eosinophilic Esophagitis
- Time to Diagnosis in Eosinophilic Esophagitis
- Adrenal Insufficiency due to Fluticasone in EoE
- Higher Doses of Topical Steroids for Eosinophilic … – gutsandgrowth
Also, from Johns Hopkins: COVID19 Caseload & Outcomes Worldwide