The following is a summary of “Ethical Implications of Continuing Oral Immunotherapy After the Development of Eosinophilic Esophagitis,” published in the December 2023 issue of Allergy & Immunology by Wilson, et al.

Maintenance treatment is necessary for patients who suffer from eosinophilic esophagitis (EoE), which is a chronic allergic inflammatory illness. Historically, eosinophilic eosinophilia (EoE) has been considered a contraindication to oral immunotherapy (OIT) and a reason for terminating treatment because OIT has the potential to generate EoE. 

Following the discontinuation of OIT, most patients with OIT-induced EoE have symptom relief and histologic remission; however, this is not always the case. Recent investigations have shown that OIT continues even after the commencement of EoE, which is contrary to the standard of treatment that was previously recognized. As a result, allergists who treat these patients face issues not just in the clinical realm but also in the ethical realm. They explored the ethical implications of pursuing desensitization despite the possible difficulties associated with EoE. 

They considered the existing research on EoE and OIT and the basic principles of medical ethics, which are beneficence, nonmaleficence, autonomy, and fairness. When ethical standards conflict with one another, it is recommended that collaborative decision-making be used to evaluate whether OIT should be maintained after an EoE diagnosis. When deciding whether patients who have been diagnosed with EoE should continue to receive OIT, allergists encounter several ethical problems, which are discussed in this article.

Source: sciencedirect.com/science/article/abs/pii/S2213219823009121