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Development Of Eosinophilic Esophagitis To Food After Development Of IgE Tolerance To The Same Food
Tuesday, March 4, 2014: 2:30 PM
Room 2 (Convention Center)
Solrun Melkorka Maggadottir, MD, , ,
Rationale:

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. 

Methods:

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. 

Results:

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. 

Conclusions:

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.