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This study has aimed to investigate whether the recently observed sensitization to <jats:italic>Candida albicans<\/jats:italic> in patients with EoE is owing to pre\u2010existing disease and its underlying abnormal epithelial barrier or, alternatively, is linked to corticosteroid (<jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>) therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Medical histories, as well as serum and tissue samples of 60 patients with EoE (15 <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> naive, 45 with current or previous <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> therapy) and 20 controls, stored in the Swiss Eosinophilic Esophagitis Database (<jats:styled-content style=\"fixed-case\">SEED<\/jats:styled-content>) and Biobank, were analyzed. We applied Immuno<jats:styled-content style=\"fixed-case\">CAP<\/jats:styled-content> to measure IgE levels and immunofluorescence techniques to examine epithelial barrier components.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with EoE had higher total IgE levels and were more frequently sensitized to <jats:italic>C. albicans<\/jats:italic> than controls. In EoE tissue specimens, increased numbers of eosinophils and mast cells, a higher expression levels of thymic stromal lymphopoietin (<jats:styled-content style=\"fixed-case\">TSLP<\/jats:styled-content>), cathelicidin, proteases, that is, the kallikreins (<jats:styled-content style=\"fixed-case\">KLK<\/jats:styled-content>)\u20105 and <jats:styled-content style=\"fixed-case\">KLK<\/jats:styled-content>\u20107, were observed as compared with controls, while reduced expression of lympho\u2010epithelial Kazal\u2010type\u2010related inhibitor (<jats:styled-content style=\"fixed-case\">LEKTI<\/jats:styled-content>), filaggrin, E\u2010cadherin, claudin, occludin, desmoglein\u20101 was found, independent of <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> therapy. In <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\u2010treated EoE, significantly lower numbers of <jats:styled-content style=\"fixed-case\">CD<\/jats:styled-content>1a+ cells and cathelicidin expression were noted as compared to <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>\u2010naive EoE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study provides further evidence that EoE is associated with an abnormal epithelial barrier and postulates that <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> therapy, by reducing innate immune mechanisms, may promote <jats:italic>C. albicans<\/jats:italic> colonization and likely subsequent sensitization.<\/jats:p><\/jats:sec>","DOI":"10.1111\/all.13244","type":"journal-article","created":{"date-parts":[[2017,7,16]],"date-time":"2017-07-16T13:06:41Z","timestamp":1500210401000},"page":"239-247","source":"Crossref","is-referenced-by-count":70,"title":["Evidence of an abnormal epithelial barrier in active, untreated and corticosteroid\u2010treated eosinophilic esophagitis"],"prefix":"10.1111","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8965-9407","authenticated-orcid":false,"given":"D.","family":"Simon","sequence":"first","affiliation":[{"name":"Department of Dermatology Inselspital, Bern University Hospital University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Page","sequence":"additional","affiliation":[{"name":"Department of Dermatology Inselspital, Bern University Hospital University of Bern Bern 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