Pediatric eosinophilic esophagitis: the Vanderbilt experience

Background: Eosinophilic esophagitis (EoE) is a chronic allergic disease of the esophagus unresponsive to treatment with proton pump inhibitors. A combination of immediate, IgE- mediated and delayed, and non-IgE-mediated immune reactions to foods and aeroallergens is thought to contribute to disease pathogenesis. Optimal methods to assess for food allergen sensitization have been debated. Patients with EoE often have comorbid atopic diseases. Objective: To characterize pediatric patients diagnosed with EoE at a single institution within the southeastern United States. Methods: A retrospective study was conducted to evaluate 211 pediatric patients with EoE at Vanderbilt University Medical Center. Aeroallergen and food sensitization profiles obtained by skin prick testing (SPT), atopy patch testing (APT), and history of associated atopic diseases were analyzed. Results: Older patients with EoE showed greater aeroallergen sensitization; the most common allergens were pollens and dust mite. Younger patients showed greater sensitization to foods by SPT and APT. The most common foods identified by SPT were peanut, egg, and soy. The most common foods identified by APT were potato, pork, and wheat. Comorbid atopic disease was common. Patients with atopic dermatitis did not show significantly greater sensitization to foods by SPT or APT compared with patients without atopic dermatitis. Conclusion: In pediatric patients with EoE, sensitization to aeroallergens increases with age, whereas sensitization to foods decreases with age. Concomitant atopic disease is common. APT is useful to identify additional food allergens not detected by SPT. A history of atopic dermatitis does not appear to be associated with nonspecific positivity by SPT or APT. (C) 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.