Presence of Food Allergy Alters the Presentation of Pediatric Eosinophilic Esophagitis
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Barry J. Pelz, MD, Joshua B. Wechsler, MD, Anusha Reddy Gaddam, MS, Katie Amsden, MPH, Barry Wershil, MD, Amir F. Kagalwalla, MD, Paul Bryce, PhD
Rationale: A transition from food allergy (FA) to eosinophilic esophagitis (EoE) after immunotherapy has been described, yet the pathophysiologic interaction between these diseases remains unclear.

Methods: Utilizing a database-approach that captures clinical, medical and laboratory data, we characterized a cohort of pediatric EoE patients to determine the prevalence of EoE+FA (as defined by history and detection of food-specific IgE by SPT and/or serologic testing) and differences in presentation compared to EoE-FA by McNemar’s test. 

Results: We found that 58 (29%) of our EoE patients had evidence of FA, suggesting FA may be more prevalent in EoE than previously appreciated. The EoE+FA cohort was significantly younger than EoE-FA (6.06 versus 8.13 years), suggesting EoE manifests earlier when FA is present. 74.6% of the EoE+FA cohort had allergic rhinitis, versus only 44% of the EoE-FA (p<0.0001). EoE+FA subjects could be easily identified due to dramatically higher IgE to multiple foods, including milk, egg, soy, wheat, peanut, and tree nuts, and an increased likelihood for positive skin prick tests. Further characterization revealed that EoE+FA subjects presented with significantly more dysphagia (15/40 versus 21/87 reported, p<0.0001), gagging (14/40 versus 8/87, p<0.0005), and chest pain (5/40 versus 10/87, p<0.05) and surprisingly significantly more rings on EGD and eosinophils on biopsy (p<0.05, respectively).

Conclusions: Our findings suggest a subtype of EoE in which IgE-mediated food allergy may impact aspects of EoE. Importantly, while these patients could be identified based on measures of food allergy, several measures of EoE were more pronounced, including both local esophageal features and incidence of symptoms.