Eosinophilic esophagitis (EoE) is characterized by chronic, isolated esophageal infiltration with eosinophils triggered by foods. Atopic disease and IgE-mediated food allergy are common in EoE. The pathogenesis of EoE is elusive with recent data suggesting a mechanism of disease independent from IgE.
We evaluated the frequency of IgE-mediated food allergy in subjects with EoE, and compared culprit food allergens in subjects with IgE-mediated food allergy who went on to develop EoE.
A retrospective analysis of 1025 children with EoE seen at the Children’s Hospital of Philadelphia in 2000-2012. A causative food was identified in 425 subjects. Skin prick tests (SPTs) were conducted and clinical IgE-mediated reactions identified. A food was considered to cause EoE if elimination led to resolution of esophageal eosinophilia or reintroduction led to reoccurrence of EoE.
The most common foods causing EoE in 425 subjects were milk, egg, wheat and soy. We describe a subgroup of 17 subjects that developed EoE to a food after outgrowing IgE-mediated allergy to that food. The EoE causative foods were not different in this subgroup, and atopic disease was present in most subjects (94%). Two subjects had normal esophageal biopsies in the setting of IgE-mediated allergy, outgrew their IgE-mediated allergy, and subsequently developed EoE to same food upon re-introducing the food into their diet.
Along with recent studies, our findings suggest that the pathophysiology in EoE is distinct from that of IgE-mediated allergy. However, prior IgE-mediated food allergy may predispose subjects do developing EoE to the same food.