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. 2017 Mar-Apr;5(2):369-375.
doi: 10.1016/j.jaip.2016.11.020. Epub 2016 Dec 30.

The Prevalence of Eosinophilic Esophagitis in Pediatric Patients with IgE-Mediated Food Allergy

David A Hill  1 , Jesse W Dudley  2 , Jonathan M Spergel  3
Affiliations

The Prevalence of Eosinophilic Esophagitis in Pediatric Patients with IgE-Mediated Food Allergy

David A Hill et al. J Allergy Clin Immunol Pract. 2017 Mar-Apr.

Abstract

Background: Eosinophilic esophagitis (EoE) is an allergic inflammatory disease that is triggered by food allergens and characterized by progressive esophageal dysfunction. Recently, EoE has been identified in patients who underwent oral immunotherapy (OIT) for IgE-mediated food allergy, suggesting an association.

Objective: We sought to ascertain whether significant associations exist between IgE-mediated food allergies and EoE.

Methods: Using the analysis of electronic medical record data and manual chart review, we examined our subspecialty care network of 35,528 children and adolescents to identify and characterize patients with IgE-mediated and EoE food allergy. The most common food allergens were defined, and the prevalence of EoE in patients with IgE-mediated food allergy was determined. Logistic regression was used to measure the extent to which IgE-mediated food allergy to specific foods is associated with EoE.

Results: The most common causes of EoE were milk, soy, egg, grains, and meats, an allergen pattern that is distinct from that of IgE-mediated food allergy. The prevalence of EoE in patients with IgE-mediated food allergy was higher than that reported in the general population (4.7% vs 0.04%). The distribution of IgE-mediated food allergens in patients with EoE was similar to that of the general population, and IgE-mediated allergy to egg (2.27; 1.91-2.64), milk (4.19; 3.52-4.97), or shellfish (1.55; 1.24-1.92) was significantly associated with an EoE diagnosis.

Conclusions: Our findings support a clinical association between these conditions that has implications for the management of children with food allergy, and particular relevance to patients undergoing OIT.

Keywords: Eosinophilic esophagitis; Food allergy; IgE; Oral immunotherapy; Prevalence.

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Figures

Figure 1
Figure 1
EMR study cohorts. Three study cohorts were identified: (a) A cohort of 11,513 children with IgE-mediated food allergy in the absence of EoE, (b) a cohort of 570 children with concurrent IgE-mediated food allergy and EoE, and (c) a cohort of 266 children with EoE in the absence of IgE-mediated food allergy.
Figure 2
Figure 2
The most common food allergens in patients with IgE-mediated food allergy or EoE. (a) Number of diagnoses for the most common food allergens in patients with IgE-mediated food allergy. (b) Frequency of the most common food allergens in patients with IgE-mediated food allergy. (c) Number of diagnoses for the most common food allergens in patients with EoE food allergy. (d) Frequency of the most common food allergens in patients with EoE food allergy. (e) Number of diagnoses for the most common IgE-mediated food allergens in patients with EoE. (f) Frequency of the most common IgE-mediated food allergens in patients with EoE.
See this image and copyright information in PMC

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