INTRODUCTION
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease, characterized by eosinophilic inflammation of the esophagus and clinical symptoms associated with esophageal dysfunction.1,2 It is diagnosed by histopathological evaluation as ≥15 eosinophils per high powered field (hpf) in the presence of recurrent or persistent gastrointestinal symptoms and excluding secondary causes.1,3 The main gastrointestinal symptoms are solid food dysphagia and food impaction in adolescents and adults.1 On the other hand, children may present different symptoms such as abdominal pain, nausea, vomiting, food refusal.2,3
Recently, a new phenomenon has been described in adult EoE patients called food-induced immediate response of the esophagus (FIRE)4. It is suspected in the presence of unpleasant even painful symptoms that occur suddenly on contact of the triggering food with the esophageal surface and recur with repeated exposures to the same food.4 These symptoms are unrelated to solid food dysphagia and food impaction, which are well described by patients with EoE. In contrast in case of FIRE, patients usually complain about narrowing, choking and pressure in the esophagus and/or retrosternal region immediately after ingestion of the triggering food.4,5
However, FIRE can often be mistaken for and coexist with pollen-food allergy syndrome (PFAS), so it is important to differentiate between the two.4,5 Similar to PFAS, FIRE is often triggered by fresh fruits and vegetables and develops rapidly.4Unlike PFAS, symptoms such as itching, tingling, and numbness which typically occur in the oropharyngeal cavity, are not observed in FIRE.4,6
So far, FIRE has been reported in eight adult cases5and in only one pediatric case7 and first described in a survey based study on EoE experts and patients.4 In this study, for the first time, we screened children with EoE aged ≥7 years old for FIRE.