Review for 10.1186/s12876-020-01554-y (2020)

Reviewer’s report
Title: 
Delayed hypersensitivity reaction to orodispersible budesonide in a case
with eosinophilic esophagitis
Version: 
0 
Date: 
03 Jun 2020
Reviewer's report:
Dear Authors,
I have read with true interest your manuscript 
"Delayed hypersensitivity reaction
to orodispersible budesonide (Jorveza®) in a case with eosinophilic esophagitis".
Please find here my comments:
1. Although authors clearly affirm that " how sensitization to budesonide
occurred remains open", they also affirm that Swallowed Topical Corticosteroids
(STCs) " can cause allergy that may hamper an optimal therapeutic course".
[abstract line 22 and page 5 line 47-48]. 
This is confusing because the terminology "can cause allergy" makes think that
Jorveza has caused a de novo allergy ( sensitization + allergic reaction) and this
is not obvious because:
i) 
the patient had already used inhaled budesonide years before and 
ii) the interval between the first intake of Jorveza and the onset of oral symptoms
was very short 
[page 4 - line 18 
"some hours after the intake of the first" dose of
Jorveza], which is not typical of a de 
novo delayed hypersensitivity drug reaction.
Authors should consider adopting a different terminology. Instead of " STCs can
cause allergy that may hamper an optimal therapeutic course", I would suggest "
allergic reactions to STCs may hamper an optimal therapeutic course".
2. In the abstract it should not be affirmed that " Three days after the first intake,
she developed oral mucosal symptoms" because symptoms occurred upon the
very first intake as reported at page 4 - line 18.
3. Was the patient symptoms free between day 1 and day 4? Or did she have
persisting oral symptoms? Authors should consider openly describing this, for
the sake of an accurate description of the temporal evolution of symptoms.
4. Authors report that the patient was prescribed inhaled budesonide for asthma
in 2003. 
Did the patient experience any symptoms during that 6 months period? 
Authors could consider reporting in the text whether the patient has been asked
this specific question or not ( and, in case, the answer should be reported).
Specific investigation about reactions to budesonide, although hampered by
possible recall biases, could give a speculative - albeit limited - clue for the
presence or absence of prior sensitization to budesonide. 
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the
authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments to the authors.
No
Are you able to assess any statistics in the manuscript or would you
recommend an additional statistical review?
If an additional statistical review is recommended, please specify what aspects
require further assessment in your comments to the editors.
Not relevant to this manuscript
Quality of written English
Please indicate the quality of language in the manuscript:
Acceptable
Declaration of competing interests
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