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.