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Eosinophilic esophagitis: New addition to the atopic march

Children who are diagnosed with skin, food, and respiratory allergies should undergo early screening for eosinophilic esophagitis (EoE), an emerging food allergy that manifests as a painful inflammation of the esophagus. Investigators concluded that EoE should be considered as a later manifestation of the atopic march or allergic march (Journal of Allergy and Clinical Immunology: In Practice June 25, 2018).

“The more allergies a child has, the higher is that child’s risk of developing EoE,” said lead study author Dr. David A. Hill, an allergist at Children’s Hospital of Philadelphia (CHOP) in Philadelphia in a press release. “The connection among these allergies suggests a common underlying biological cause, and also may imply that if we can successfully treat an earlier type of allergy, we may prevent later allergies.”

EoE has low mortality, but high morbidity, in contrast to classic, potentially life-threatening anaphylactic food allergies, like a peanut allergy. It has slow-onset symptoms, such as pain in swallowing, reflux, stomach ache, and food impaction. Both types of allergies are triggered by specific foods, but the culprit in EoE may not be as obvious. A child may need to follow a restricted diet until healthcare providers can pinpoint the offending food. Furthermore, EoE may be slow to manifest, and can sometimes be misdiagnosed or remain undiagnosed well into the child’s teenaged years.

Patients with EoE experience a swelling of the esophagus,

characterized by multiple rings and linear furrows.

Copyright free image from Wikimedia Commons.

The researchers analyzed health records in a longitudinal cohort of over 130,000 patients in the CHOP pediatric network. The patients were followed from birth to adolescence, to determine whether and when patients acquired allergic diseases. The researchers also compared the risk of developing EoE between allergic and non-allergic children.

“We found that if children had three allergies other than EoE, they were nine times more likely to develop EoE than children with no pre-existing allergies,” said Dr. Hill.

The peak age of EoE diagnosis was 2.6 years old. In addition, compared to children without EoE, children with EoE had a higher risk developing the respiratory allergy allergic rhinitis, also known as seasonal allergies.

Further investigating the underlying biological mechanisms among different allergies will be the next questions that need to be studied, according to Dr. Hill.

“Ultimately, we hope to find that intervening earlier in the allergic march, for example, in treating allergic skin conditions, may interrupt the march and prevent the child from developing later disorders such as EoE,” he said.

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