Food Allergen Component Sensitization Patterns in Eosinophilic Esophagitis: Insights from a Retrospective Comparative Study

Eosinophilic esophagitis (EoE) is a chronic, food-driven inflammatory disorder of the esophagus in which repeated exposure to dietary antigens plays a central role, yet identification of relevant food triggers remains largely empirical. In this retrospective single-center study, molecular IgE sensitization profiles were evaluated in adult patients with EoE and compared with an allergic control group with chronic urticaria using component-resolved diagnostics. IgE sensitization was common in both cohorts and predominantly reflected inhalant-related, cross-reactive components, particularly PR-10 proteins, indicating a shared sensitization background. In contrast, sensitization to structurally stable food allergen components, including lipid transfer proteins and plant storage proteins, was observed exclusively in patients with EoE. These food-derived components are characterized by resistance to thermal processing and gastrointestinal digestion, supporting their potential relevance as markers of sustained mucosal exposure rather than acute IgE-mediated reactions. Although component-resolved diagnostics showed limited utility for direct identification of trigger foods, the selective presence of stable food ingredient sensitization may help define a distinct food-driven EoE phenotype. These findings emphasize the importance of considering molecular properties of food ingredients when interpreting sensitization patterns in chronic, diet-related inflammatory diseases. Using component-resolved diagnostics (CRD) as an immunological tool for food allergen component characterization, we highlight an emerging EoE-associated sensitization signature enriched for structurally stable, digestion-resistant allergen families. If validated prospectively, this marker pattern may support immunophenotyping and stratification of EoE patients for targeted dietary evaluation rather than stand-alone trigger identification.