FOOD-INDUCED IMMEDIATE RESPONSE OF THE ESOPHAGUS (FIRE) IN PEDIATRIC
EOSINOPHILIC ESOPHAGITIS
Abstract
Background: Food-induced immediate response of the
esophagus (FIRE) is a new phenomenon that has been described in
eosinophilic esophagitis (EoE) patients. It is suspected when unpleasant
symptoms occur suddenly on contact of the triggering food with the
esophageal surface and recur with repeated exposures. It can often be
mistaken for pollen-food allergy syndrome (PFAS) and solid food
dysphagia. Data on FIRE is limited to one survey study and case reports,
and there are no screening studies conducted on either adults or
children with EoE. In this study, we aimed to screen children aged ≥7
years old with EoE for FIRE. Methods: Demographic data
were collected from medical records. A questionnaire about FIRE was
applied to all participants. Skin prick tests (SPTs) were done on
suspected patients to identify the triggering foods. FIRE is defined as
suitable clinical symptoms with suspected food allergen exposure.
Results: Seventy-eight patients (74.4% male, median
age: 13.5 years) were included. Unpleasant and recurrent symptoms
distinct from dysphagia with specific foods were reported in %16.7 of
the patients, all of whom had concomitant allergic rhinitis (AR). The
symptoms described by almost all patients were oropharyngeal itching and
tingling (PFAS: 15.3%) excluding only one patient reporting
retrosternal narrowing and pressure after specific food consumption
(FIRE: 1.2%). Conclusions: Although definitive
conclusions regarding the true prevalence of FIRE cannot be made, it
does not seem to be common as PFAS. However, it deserves questioning
particularly in the presence of concurrent AR and/or PFAS in children
with EoE.