The Diagnosis of Esophageal Eosinophilia is Not Increased in the Summer Months

Abstract

Smaller studies have suggested seasonal variation of the diagnosis of eosinophilic esophagitis with more patients being diagnosed in the aeroallergen season. We evaluated a large group of adult patients for a seasonal variation of the diagnosis of symptomatic eosinophilic esophageal infiltration. We performed a retrospective review of adult patients from a large Eosinophilic esophagitis database at the Mayo Clinic Rochester. We only included patients from three states in the upper Midwest, who had 15 or more eosinophils per high-power field on esophageal biopsy, symptomatic dysphagia, and were seen, in our Gastroenterology Clinic between 2000 and 2008. Clinical data were abstracted and the month of diagnosis was determined. The Rayleigh circular test and the Chi-square goodness-of-fit test were used to detect seasonality of symptomatic esophageal eosinophilia diagnosis and seasonality corrected for esophagogastroduodenoscopy monthly volume. The diagnosis of symptomatic eosinophilic esophageal infiltration was made in 372 patients. The mean number of eosinophils was 39.6 per high-power field. The December/January and May/June periods seem to have an increased presentation rate (p = 0.014). Of those tested, reactions to any aeroallergen was present in 69 % (48/70), reactions to >4 aeroallergens in 47 % (33/70) and reactions to any food allergen in 63 % (50/80) of patients. There was no evidence of monthly concentration of symptomatic esophageal eosinophilia diagnosis in the subgroups of patients with any positive aeroallergen, >4 positive aeroallergens, or history of atopy. The diagnosis of symptomatic esophageal eosinophilia is not made more frequently in the summer months.

The Role of Environmental Exposures in the Etiology of Eosinophilic Esophagitis

“…One article was a case report, 33 two were case series, 30,34 one was a cross sectional study, 35 nine were case-control, 36-44 and six were cohort studies. 45-50 All articles were written in the last decade, with the earliest published in 2007. One study was conducted in Spain, 35 one in Canada, 40 and another in Australia, 42 with the remaining eleven completed in the US.…”

“…41,45,47-50 The first used a retrospective cohort design to compare rates of EoE diagnosis across seasons and adjusted for seasonal esophagogastroduodenoscopy (EGD) case volume. 45 They found that EoE diagnosis was more common in spring and summer, or outdoor months, than winter and fall, or indoor months.…”

Disease associations in eosinophilic oesophagitis and oesophageal eosinophilia

“…Atopic features and allergy sensitization patterns in EoE patients are not different from those atopic non-EoE individuals living in the same geographical area and exposed to common allergens [33], with no significant differences regarding history of allergic rhinitis, atopic dermatitis, immunoglobulin E-mediated food allergy or sensitization to aeroallergens, and family history of atopy found between children and adults with EoE [34]. A potential role of airborne allergens in triggering the disease has also been suggested after observing seasonal variations in the incidence of EoE [35], but results that have not been universally reproduced [36,37].…”

Eosinophilic Esophagitis–More than Two Decades of Progress

“…In comparison, a 2013 study of children diagnosed with EoE showed there was no significant association with different seasons and EoE diagnosis (P=0.2035) [19]. A more recent study in 2014 by Elias et al also showed a different trend with peak periods of diagnosis for symptomatic esophageal eosinophilia in December-January (11-13%), and less in May-June (11 -9%) (p=0.014) [20]. Along with aeroallergens, food antigenic triggers exist.…”