Ethical Implications of Continuing Oral Immunotherapy After the Development of Eosinophilic Esophagitis.
Ethical Implications of Continuing Oral Immunotherapy After the Development of Eosinophilic Esophagitis.
复制标题
嗜酸性粒细胞性食管炎发生后继续口服免疫治疗的伦理意义。
DOI：
10.1016/j.jaip.2023.08.012
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Wright,BenjaminL
中科院分区：
文献类型：
--
作者：
Wilson,BridgetE;Meltzer,EllenC;Wright,BenjaminL
嗜酸性食管炎（EoE）是一种需要维持治疗的慢性变应性炎症性疾病。传统上，EoE一直是口服免疫疗法（OIT）的禁忌症，也是停止治疗的理由，因为OIT可能诱发EoE。大多数，但不是所有的OIT诱导的EoE患者在停止OIT后症状消退和组织学缓解。最近的研究报告OIT持续，即使在EoE发作后，尽管以前接受的护理标准。这为治疗这些患者的过敏症专家带来了临床和伦理挑战。考虑到EoE和OIT的已发表文献和基本的医学伦理学原则的善行，nonmaleficence，自主权和正义，我们讨论了追求脱敏，尽管潜在的并发症与EoE的伦理影响。当伦理原则是在反对，共同决策应采用，以确定是否OIT应继续EOE诊断后。本文强调了变态反应科医生在确定诊断为EoE的患者是否应该继续OIT时所面临的伦理困境。
Eosinophilic esophagitis (EoE) is a chronic allergic inflammatory disease requiring maintenance therapy. Traditionally, EoE has been a contraindication to oral immunotherapy (OIT) and a rationale for discontinuing treatment because OIT may induce EoE. Most, but not all patients with OIT-induced EoE experience symptom resolution and histologic remission after discontinuing OIT. Recent studies report OIT continuation even after EoE onset, despite the previously accepted standard of care. This creates clinical as well as ethical challenges for allergists treating these patients. Considering the published literature on EoE and OIT and the primary medical ethics principles of beneficence, nonmaleficence, autonomy, and justice, we discuss the ethical implications of pursuing desensitization despite the potential complications associated with EoE. When ethical principles are in opposition, shared decision-making should be employed to determine whether OIT should be continued after an EoE diagnosis. This article highlights the ethical dilemmas allergists face when determining whether patients with a diagnosis of EoE should continue OIT.