IgE-Mediated Food Sensitization, Management Strategies, and Quality of Life in Pediatric Eosinophilic Esophagitis: A Prospective Observational Study

Abstract

Background: Eosinophilic esophagitis is a chronic immune-mediated disease with increasing prevalence. In pediatric populations, it often coexists with IgE-mediated food sensitization. This dual diagnosis presents unique therapeutic challenges, including on the one hand both temporary and lifelong dietary restrictions, and on the other hand, therapeutic interventions with a potential impact on quality of life (QoL). Objectives: This study prospectively evaluated the prevalence of IgE-mediated food sensitization and allergy in children with EoE attending a tertiary center in Flanders, Belgium. Additionally, it prospectively documented dietary habits and restrictions in these children, with or without concomitant IgE-mediated food allergies, and assessed the impact of dietary management on quality of life compared to pharmacological treatment. Methods: We consecutively followed 30 children with biopsy-confirmed pediatric EoE (PedEoE) attending a tertiary referral center for at least 12 months. Patient demographics, allergy testing, dietary history, and treatment modalities were recorded. Symptom score and PedEoE QoL were assessed using validated Pediatric Eosinophilic Esophagitis Symptom Score (PEESS 2.0) and Pediatric Quality of Life Inventory (PedsQL 3.0) questionnaires. Statistical analysis was performed using the Mann-Whitney U test and Kruskal-Wallis test with Dunn's test as a post hoc test. Results: Among 30 children with EoE (60% male, median age 8 years), 60 PedEoE QoL (PedsQL) and 39 symptom (PEESS) questionnaires were collected at one or more time points over a median follow-up of 14.5 months. IgE sensitization to common dietary triggers was observed in multiple patients, with varying clinical reactivity. Symptom scores tended to be higher in children without histological remission, though differences were not statistically significant (median PEESS 23.75 vs. 17.50, p = 0.1934). Grouped by degree of dietary restriction, QoL scores showed significant differences (child p = 0.0102; parent p = 0.0203), with children in the 1-2 food elimination group reporting better QoL compared to the 0 food elimination and >6 food elimination groups. No clear statistically significant differences were observed between the 1-2 food elimination group and the 3-4 or 5-6 food elimination groups. Conclusions: IgE sensitization is prevalent among pediatric EoE patients and has significant clinical implications for disease management. Treatment choice can influence not only disease control but also the QoL of both patients and their families.

Keywords: QoL; food sensitization; pediatric eosinophilic esophagitis.

Figure 1

Total IgE level (kU/L) and specific IgE levels (kU/L) to different food allergens in individual study patients.