Clinical and Applied Immunology Reviews 4 (2003) 173–188 Eosinophilic esophagitis in children A review Rajesh Kumar a , Timothy Sentongo b , Suzanne P Nelson b , Hector Melin-Aldana c , B UK Li b, * Divisions of a Allergy, b Gastroenterology/Hepatology and Nutrition, and c Departments of Pediatrics and Pathology, Children’s Memorial Hospital, 2300 Children’s Plaza, #57 Chicago, IL Chicago, IL 60614-3394 USA Received 31 January 2003; received in revised form 19 May 2003; accepted 22 May 2003. Abstract Eosinophilic esophagitis is a newly described clinicopathologic entity that is being diagnosed with increasing frequency. Although accepted diagnostic criteria have not been established, the presence of dense eosinophilic inflammation of esophageal mucosa are key. Because of the reflux-type symptomatology, it is commonly misdiagnosed and treated as severe gastroesophageal reflux disease before an appropriate diagnosis is made. The role of food allergens in this disorder is well accepted but the task of identifying specific antigens remains a clinical challenge. Based on animal studies, the pathophysiology appears to involve inflammatory cytokines, interleukin 5 (IL- 5) and eotaxin. Therapy remains problematic because of steroid side effects, the unpalatability of the elemental diet, and lack of rigorously designed trials.  2004 Elsevier Inc. All rights reserved. Keywords: Allergic esophagitis; Eosinophilic esophagitis; Food allergy; Interleukin 5; Eotaxin. 1. Introduction Eosinophilic esophagitis (EE) is a gastrointestinal disorder manifested predominantly by reflux-type symptoms that do not respond to standard anti-reflux pharmacotherapy. Although only recently recognized as an entity distinct from gastroesophageal reflux disease (GERD) Abbreviations: EE, eosinophilic esophagitis; GERD, gastroesophageal reflux disease; GI, gastrointestinal; hpf, high power field; IFN, interferon; Ig, immunoglobulin; IL, interleukin; MBP, major basic protein; RAST, radioallergosorbent testing; RNA, ribonucleic acid; TNF, tumor necrosis factor. * Corresponding author. Tel.: +1-773-880-4196; fax: +1-773-880-4036. E-mail address: bli@northwestern.edu (B Li). 1529-1049/04/$ – see front matter  2004 Elsevier Inc. All rights reserved. doi: 10.1016/j.cair.2003.05.001