Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2018 Sep-Oct;6(5):1528-1533.
doi: 10.1016/j.jaip.2018.05.010. Epub 2018 Jun 25.

Eosinophilic Esophagitis Is a Late Manifestation of the Allergic March

David A Hill  1 , Robert W Grundmeier  2 , Mark Ramos  2 , Jonathan M Spergel  3
Affiliations
Comparative Study

Eosinophilic Esophagitis Is a Late Manifestation of the Allergic March

David A Hill et al. J Allergy Clin Immunol Pract. 2018 Sep-Oct.

Abstract

Background: The allergic march describes the natural history of allergic conditions as they develop during childhood. Eosinophilic esophagitis (EoE) is a chronic allergic inflammatory disease that can be triggered by specific foods. Despite its allergic pathophysiology, the epidemiologic relationship between EoE and established members of the allergic march is unknown.

Objective: We sought to determine whether EoE meets epidemiologic criteria for being considered a member of the allergic march.

Methods: Using a primary care birth cohort of 130,435 children, we determined the natural histories of atopic dermatitis (AD), IgE-mediated food allergy (IgE-FA), asthma, EoE, and allergic rhinitis (AR) in individual patients. We then performed case-control analyses to establish the extent that existing allergic conditions influence the rate of subsequent EoE diagnosis.

Results: A total of 139 children developed EoE during the observation period (prevalence of 0.11%). The peak age of EoE diagnosis was 2.6 years, as compared with 0.3 years, 1 year, 1.1 years, and 2.1 years for AD, IgE-FA, asthma, and AR, respectively. The presence of AD (hazard ratio [HR] 3.2, 95% confidence interval [CI] 2.2-4.6), IgE-FA (HR 9.1, 95% CI 6.5-12.6), and asthma (HR 1.9, 95% CI 1.3-2.7) was independently and cumulatively associated with subsequent EoE diagnosis. The presence of AR was associated with subsequent EoE diagnosis (HR 2.8, 95% CI 2.0-3.9), and the presence of EoE was associated with subsequent AR diagnosis (HR 2.5, 95% CI 1.7-3.5).

Conclusions: Allergic comorbidities are positively associated with EoE diagnosis. Together, our findings suggest that EoE is a late manifestation of the allergic march.

Keywords: Allergic march; Allergic rhinitis; Asthma; Atopic dermatitis; Eosinophilic esophagitis; Food allergy.

PubMed Disclaimer

Conflict of interest statement

Author Contributions and Disclosures: The authors have no conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
The allergic march. Density incidence of atopic dermatitis (AD), IgE-mediated food allergy (IgE-FA), asthma, allergic rhinitis (AR), and eosinophilic esophagitis (EoE) by age.
FIGURE 2
FIGURE 2
Cox hazard ratios indicating effect of primary allergic diagnosis on likelihood of secondary allergic diagnosis. White represents no correlation and red represents positive correlation, with darker color representing stronger relationship.
FIGURE 3
FIGURE 3
Presence of allergic disease increases likelihood of EoE diagnosis. (A) Kaplan-Meier curve displaying influence of AD on EoE diagnosis by age. (B) Influence of IgE-FA on EoE diagnosis by age. (C) Influence of asthma on EoE diagnosis by age. (D) Influence of one or more atopic conditions on EoE diagnosis by age.
FIGURE 4
FIGURE 4
AR and EoE are bi-directionally associated. (A) Kaplan-Meier curve displaying influence of AR on EoE diagnosis by age. (B) Influence of EoE on AR diagnosis by age.
See this image and copyright information in PMC

References

    1. Hill DA, Spergel JM. The atopic march: Critical evidence and clinical relevance. Ann Allergy Asthma Immunol. 2018 Feb;120(2):131–7. - PMC - PubMed
    1. Belgrave DC, Granell R, Simpson A, Guiver J, Bishop C, Buchan I, et al. Developmental profiles of eczema, wheeze, and rhinitis: Two population-based birth cohort studies. PLoS Med. 2014 Oct 21;11(10):e1001748. - PMC - PubMed
    1. Tsakok T, Marrs T, Mohsin M, Baron S, du Toit G, Till S, et al. Does atopic dermatitis cause food allergy? A systematic review. J Allergy Clin Immunol. 2016 Apr;137(4):1071–8. - PubMed
    1. Gustafsson D, Sjoberg O, Foucard T. Development of allergies and asthma in infants and young children with atopic dermatitis–a prospective follow-up to 7 years of age. Allergy. 2000 Mar;55(3):240–5. - PubMed
    1. Hill DA, Grundmeier RW, Ram G, Spergel JM. The epidemiologic characteristics of healthcare provider-diagnosed eczema, asthma, allergic rhinitis, and food allergy in children: A retrospective cohort study. BMC Pediatr. 2016 Aug 20;16 133,016-0673-z. - PMC - PubMed

Publication types

Substances