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Background Links between food allergens and eosinophilic esophagitis have been established, but the interplay between EoE and IgE-associated immediate hypersensitivity to foods remains unclear. Objective We sought to determine the prevalence of IgE-associated food allergy at time of diagnosis of EoE in children and to determine if differences existed in presentation and disease compared to subjects with EoE alone. Methods EoE patients were stratified based on diagnosis of IgE-associated immediate hypersensitivity (EoE+IH versus EoE-IH). Clinical, histologic, pathologic, and endoscopic differences were investigated using a retrospective database. Results We found that 29% of the 198 EoE patients in our cohort had EoE+IH. These subjects presented at a younger age than those without IH (6.05 years vs 8.09 years, p=0.013) and were more likely to have comorbid allergic disease. Surprisingly, the EoE+IH group presented with significantly different clinical symptoms, with increased dysphagia, gagging, cough, and poor appetite compared to their counterparts in the EoE-IH group. Male gender, allergic rhinitis, the presence of dysphagia, and younger age were independently associated with having EoE+IH. Specific IgE levels to common EoE-associated foods were higher in EoE+IH, regardless of eliciting immediate hypersensitivity symptoms. In contrast, IgE levels for specific foods triggering EoE were relatively lower in both groups than IgE levels for immediate reactions. Conclusions & Clinical Relevance Immediate hypersensitivity is common in children with EoE, and identifies a population of EoE patients with distinct clinical characteristics. Our study describes a subtype of EoE in which IgE-mediated food allergy may impact the presentation of pediatric EoE.

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Children who begin wheezing during early childhood are seen frequently by health care providers in primary care, in hospitals and emergency departments, and by allergists and pulmonologists. When young children, like the 2 year-old case presented here, are evaluated for wheezing, a frequent challenge for clinicians is to determine whether the symptoms represent transient, viral-induced wheezing, or whether sufficient risk factors are present to suspect that the child may experience recurrent wheezing and develop asthma. Most factors influencing prognosis are not mutually exclusive, are interrelated (i.e., cofactors), and often represent gene-environment interactions. Many of these risk factors have been, and continue to be, investigated in prospective studies in order to decipher their relative importance with the goal of developing new therapies and interventions in the future. The etiologies of wheezing in young children, diagnostic methods, treatment, prognostic factors, and potential targets for prevention of the development of asthma are discussed.