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.