Meta-analysis finds 2.31% EoE incidence with food allergen immunotherapy, none with aeroallergen SLITStudy finds link between food allergy treatment and rare swallowing condition

Allergy Published April 2, 2026 Study authors: Rossi Carlo Maria, Terreehorst Ingrid, Apostolidou Evaggelia, Votto Martina, Bakirtas Arzu, Cianferr… PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

Consider monitoring for EoE in patients on food allergen immunotherapy, based on observational association.

This systematic review and meta-analysis examined the incidence of confirmed eosinophilic esophagitis (EoE) as a side effect of allergen immunotherapy (AIT). The analysis included 17 studies, with 15 on food desensitization (oral immunotherapy with food allergens, n=3302 patients) and 2 on sublingual immunotherapy with aeroallergens (n=1436 patients). The study design, setting, and follow-up duration were not reported.

The primary outcome was the incidence of confirmed EoE. In food desensitization studies, the pooled incidence was 2.31% (95% CI 1.45, 3.36). In the two studies on sublingual immunotherapy with aeroallergens, 0 cases were reported among 1436 patients. No comparator group was reported for this analysis.

EoE was reported as an adverse event. Data on serious adverse events, discontinuations, and general tolerability were not reported. A key limitation is that only two studies on sublingual immunotherapy with aeroallergens met the inclusion criteria, limiting the certainty of the finding of no cases. The evidence describes an association from observational data; causation is not explicitly established.

For practice, this meta-analysis suggests clinicians should be aware of a potential association between food allergen immunotherapy and EoE, with an observed incidence around 2-3%. The apparent absence of cases with aeroallergen SLIT is based on very limited evidence. These findings should be interpreted cautiously due to the observational nature of the included studies.

Researchers analyzed existing studies to see if allergy treatments might be linked to a rare swallowing condition called eosinophilic esophagitis (EoE). They looked at 17 studies involving patients receiving allergen immunotherapy—15 studies on food desensitization (3,302 patients) and 2 studies on sublingual immunotherapy for airborne allergens like pollen (1,436 patients).

The analysis found that in food desensitization studies, about 2.3% of patients developed confirmed EoE. In the studies on sublingual immunotherapy for airborne allergens, no cases of EoE were reported among the 1,436 patients. EoE was described as a potential side effect in these studies.

It's important to understand this was a review of observational studies, which can show associations but not prove that the treatment directly causes the condition. The finding about airborne allergen treatments is based on only two studies, so more research is needed. Patients considering or receiving allergy treatments should discuss any concerns about potential side effects with their doctor.

What this means for you:

Food allergy treatment shows possible link to rare swallowing condition in some patients, but more research is needed.

Study Details

Study typeMeta analysis

Sample sizen = 3,302

EvidenceLevel 1

PublishedApr 2026

PMID41403138

View Original Abstract ↓

The European Academy of Allergy and Clinical Immunology (EAACI) established a Task Force to assess the existing data on the relationship between eosinophilic esophagitis (EoE) and allergen immunotherapy (AIT). This systematic review and meta-analysis aimed to study the incidence of confirmed EoE, developing as a side effect of AIT to food or airborne allergens, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. The literature search was performed in three databases (PubMed, Embase and Scopus). Databases were searched from inception to March 31st, 2023. A total of 17 studies met the criteria for inclusion in the review. Fifteen studies, comprising 3,302 patients, were on food desensitization, and the overall estimate of EoE incidence, combining the results of these individual studies, was 2.31% (95% CI 1.45, 3.36). Registered data reported de novo cases of eosinophilic esophagitis, and its diagnosis was usually made during the maintenance phase of food desensitization. With the adopted searching strategy, only two studies on sublingual immunotherapy with aeroallergens meeting the inclusion criteria were retrieved, comprising 1,436 patients and not reporting cases of EoE. The meta-analysis showed that the development of EoE is a common adverse effect of oral immunotherapy with food allergens, whereas it is uncommon during sublingual immunotherapy with aeroallergens. Trial Registration: PROSPERO: CRD42023425917.

Meta-analysis finds 2.31% EoE incidence with food allergen immunotherapy, none with aeroallergen SLITStudy finds link between food allergy treatment and rare swallowing condition

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Meta-analysis finds 2.31% EoE incidence with food allergen immunotherapy, none with aeroallergen SLITStudy finds link between food allergy treatment and rare swallowing condition

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