Most patients with eosinophilic esophagitis are highly atopic individuals: 80% have food and inhalant sensitization

This study compared the results of serum IgE testing, patch testing, and epicutaneous skin testing to measure allergic sensitization in 53 pediatric patients with eosinophilic esophagitis (EE). Food and inhalant sensitivities were assessed using skin prick testing and serum specific IgE measurement.

The overall prevalence of food and inhalant sensitization was 80%, with higher total IgE levels in sensitized vs nonsensitized patients (median, 150 vs 13 IU/mL).

For foods, serum IgE measurement detected more positive results than did skin prick testing. Specific IgE to milk was most common (43%). Inhalants were implicated as frequently as were foods.

32% of patients had a cluster of multiple sensitivities that included pollens, soy, grains, peanut, and tree nuts and had higher total IgE levels.

Most, but not all, patients with EE are highly atopic individuals with frequent allergic sensitivities. Thus, serum IgE measurement or skin prick testing may be useful in identifying relevant food sensitivities and in distinguishing subgroups of patients with EE, making a more directed approach to food avoidance possible.

The presence of allergic rhinitis, sensitization to aeroallergens, or both ranges from 42% to 93% in children with eosinophilic esophagitis. In addition, dietary therapy has a role in EoE treatment. According to the most recent consensus document, children with eosinophilic esophagitis should be evaluated for food and aeroallergen sensitization (Liacouras CC, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011 (July); 128(1):3-20.)

Treatment modalities for EoE include the 3Ds: drugs, diet, and dilation (Allergy, 2012).

References:

Serum IgE measurement and detection of food allergy in pediatric patients with eosinophilic esophagitis. Erwin EA, James HR, Gutekunst HM, Russo JM, Kelleher KJ, Platts-Mills TA. Ann Allergy Asthma Immunol. 2010 Jun;104(6):496-502.

Eosinophilic esophagitis after specific oral tolerance induction for egg protein http://goo.gl/fzmip

Repeating allergy testing in children with eosinophilic esophagitis whose original tests were negative. Ask the Expert, AAAAI, 2011.