IgE‐associated food allergy alters the presentation of paediatric eosinophilic esophagitis

Abstract

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.

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

“…(27) We measured a rate of IgE-mediated food allergy in patients with EoE of 68%, a prevalence that is higher than previously reported. (27, 28) To ensure accurate measurement of IgE-mediated food allergy in patients with EoE, we performed a manual chart review of 100 patients. In this review, 94% of patients with both an IgE-mediated food allergy and EoE diagnosis were found to have evidence of IgE-mediated allergy to at least one food.…”

“…While IgE-mediated and EoE food allergy have been reported to occur together, (14, 15, 23, 28) it is difficult to estimate simultaneous occurrence of these conditions to the same food as avoidance of the causal food in IgE-mediated food allergy ameliorates EoE symptoms. Additionally, patients with EoE and IgE-mediated food allergy may display distinct clinical symptoms as compared to those without IgE-mediated food allergy, making EoE diagnosis difficult.…”

“…Additionally, patients with EoE and IgE-mediated food allergy may display distinct clinical symptoms as compared to those without IgE-mediated food allergy, making EoE diagnosis difficult. (28) As such, there are likely a proportion of patients with concurrent IgE-mediated food allergy and EoE in which EoE is not detected. (23) We observed a higher rate of IgE-mediated food allergy in patients with EoE as compared with prior studies, (27, 28) a finding which was confirmed by manual chart review.…”

“…(28) As such, there are likely a proportion of patients with concurrent IgE-mediated food allergy and EoE in which EoE is not detected. (23) We observed a higher rate of IgE-mediated food allergy in patients with EoE as compared with prior studies, (27, 28) a finding which was confirmed by manual chart review. While differences in methodology may account for the higher rates of IgE-mediated food allergy observed in our study, it is possible that IgE-mediated food allergy is more common in patients with EoE than previously appreciated.…”

Efficacy of a 4-Food Elimination Diet for Children With Eosinophilic Esophagitis

“…This last finding has also been previously reported by Erwin et al, 17 and supports the concept that EoE patients with IgE-mediated food allergy represent a unique EoE phenotype, as we have previously reported. 18 Food sensitization seems to be a marker for a more broadly food-allergic phenotype that does not respond to FFED.…”