ORLANDO -- The emerging food allergy eosinophilic esophagitis tended to present in childhood after eczema and IgE food allergies, but slightly before seasonal allergies, according to researchers here.
Peak age of Eosinophilic esophagitis (EoE) diagnosis was 2.7 years, compared with 0.4-years, 1-year, 1.1 years, and 4.1 years for atopic dermatitis, food allergy, asthma, and allergic rhinitis, respectively, reported David A. Hill, MD, PhD of Children's Hospital of Philadelphia (CHOP), and colleagues.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Atopic dermatitis, food allergy, and asthma were independently associated with an increased risk of EoE (HR 2.7, 95% CI 1.9-4.0; HR, 8.9, 95% CI 6.3-12.4; and HR 2.2, 95% CI, 1.6-3.1, respectively), he said at the American Academy of Allergy, Asthma & Immunology and the World Allergy Organization meeting.
EoE is a chronic, allergic, inflammatory disease of the esophagus characterized by symptoms of dysphagia and gastro-esophageal reflux. It is a late manifestation of the allergic march, which refers to the typical progression of allergic diseases occurring early in life. This progression commonly starts with eczema in infancy, followed by IgE food allergies, and later by asthma and hay fever.
"The reason we suspected EoE might be part of this allergic march is because it is a food allergy with a very characteristic allergy type of inflammation," Hill explained.
Utilizing a primary care birth cohort of 130,457 children attending pediatric primary care clinics at CHOP (entered prior to 1-year of age and followed for more than 24 months), the researchers performed a case-control analysis with propensity score-matched controls designed to determine if the presence of atopic dermatitis, food allergy, asthma, and allergic rhinitis modify risk of developing EoE.
A total of 139 children developed EoE during the observation period (prevalence 0.11%). After adjustment, male gender (OR 2.7, 95% CI 1.9-4.0) and white race (OR 2.4, 95% CI 1.5-3.9) were risk factors for EoE.
The presence of EoE significantly increased risk of subsequent allergic rhinitis (HR 3.8, 95% CI, 1.4-2.7) and the cumulative effect of atopic conditions on risk of subsequent EoE was also significant (P<0.001 for all associations):
- One condition: HR 3.9 (95% CI 2.6-5.7)
- Two conditions: HR 6.5 (95% CI 4.3-9.9
- Three conditions: HR 9.8 (95% CI 5.8-16.8)
- Four conditions: HR 12.2 (95% CI 5.0- 30.0)
"We found that EoE is later in the march after eczema and IgE food allergies and asthma, but a little before seasonal allergies," Hill said. "These findings help to refine what we consider to be a pillar concept in the field of allergy -- the allergic march. In addition, it tells us something about the way these diseases are related to each other in terms of their pathophysiology."
Hill noted that the findings may help inform clinicians caring for children with allergic diseases.
"If I see a child in my clinic with early eczema who goes on to develop food allergy, I might consider monitoring that child around the age of 3 or 4 years for symptoms of EoE," he told 51˶.
Primary Source
American Academy of Allergy, Asthma & Immunology
Hill DA, et al "Eosinophilic esophagitis is a late manifestation of the atopic march" AAAAI 2018.