Monoclonal Antibody Therapy in Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disorder characterized by esophageal eosinophilic infiltration and symptoms of esophageal dysfunction, most notably dysphagia and food impaction. The prevalence of EoE has increased substantially over the past 2 decades, and the disease is now recognized as a major cause of esophageal morbidity in both adults and adolescents. Although proton pump inhibitors, swallowed topical corticosteroids, dietary elimination strategies, and endoscopic dilation remain the cornerstone of therapy, a considerable proportion of patients experience persistent symptoms, disease recurrence, or treatment-related limitations. Advances in understanding the immunopathogenesis of EoE have identified type 2 inflammatory pathways as central drivers of disease activity, leading to the development of targeted monoclonal antibody therapies. Several monoclonal antibodies directed against interleukin-4, interleukin-5, interleukin-13, and Siglec-8 have been evaluated in randomized controlled trials, demonstrating variable effects on clinical symptoms, histologic remission, and endoscopic disease severity. This review synthesizes current evidence on monoclonal antibody therapy for EoE in adolescents and adults, with emphasis on their mechanistic rationale, clinical efficacy, and limitations. Particular attention is given to the frequently observed discordance between symptomatic improvement and histologic or endoscopic response. Current guideline recommendations, regulatory considerations, and future research directions are also discussed.