High Incidence of Atopy in Young Children with Eosinophilic Esophagitis

High Incidence of Atopy in Young Children with Eosinophilic Esophagitis

Abstracts AB231 J ALLERGY CLIN IMMUNOL VOLUME 137, NUMBER 2 Allergic Background and Time to Diagnosis in Children with Eosinophilic Esophagitis in B...

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Abstracts AB231

J ALLERGY CLIN IMMUNOL VOLUME 137, NUMBER 2

Allergic Background and Time to Diagnosis in Children with Eosinophilic Esophagitis in British Columbia

Christopher Mill, BSc, MPH1, Vishal Avinashi, MD, MPH1, Timothy Teoh, BSc1, Christopher Koo, BSc1, Edmond S. Chan, MD, FAAAAI2; 1 University of British Columbia, Vancouver, BC, Canada, 2Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, BC Children’s Hospital, Vancouver, BC, Canada. RATIONALE: To assess clinical and demographic characteristics of children with eosinophilic esophagitis (EoE) in a new multidisciplinary allergy and gastroenterology clinic serving British Columbia. METHODS: Children referred to the BC Children’s Hospital EoE clinic with biopsy-proven EoE were approached to join our longitudinal EoE registry. After parents consented, data on clinical characteristics and management were recorded. Descriptive statistics and Mann-Whitney Utests examined differences between groups given that our data was not normally distributed. RESULTS: Among 63 patients assessed between July/2012 and August/ 2014, the majority (84%) were male, and median age at diagnosis was 5.8 years (IQR56.6). Forty-six percent (29) had allergy testing previously, 41% (26) had immediate food allergy (among those 17% had more than 1 food trigger and 46% (12) had experienced anaphylaxis.) Almost one-third (29%) had atopic dermatitis, 29% had allergic rhinitis, and 24% had asthma. Most were white (71%) or South Asian (25%). Among 19 (30%) patients on dietary intervention for EoE, cow’s milk (32%) and egg (21%) were the most commonly restricted foods. Most (62%) were from the Vancouver area where median time from symptom onset to diagnosis was 1.3 years (IQR51.1) versus 2.8 years (IQR54.5) for those outside the Vancouver area (p<0.05). CONCLUSIONS: This is the first EoE registry that we are aware of in Canada. The underlying factors for longer delays outside the Vancouver area need to be further explored in order to evaluate the potential need for improved EoE service access outside of the Vancouver area and better awareness of EoE presenting symptoms across British Columbia.

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High Incidence of Atopy in Young Children with Eosinophilic Esophagitis

Michelle Tobin, Rupinder K. Gill, Sunny Chang, Susan Schuval, MD, FAAAAI; Stony Brook Children’s Hospital, Stony Brook, NY. RATIONALE: Eosinophilic esophagitis (EoE) has been strongly associated with atopy in children and adults. However, there is a paucity of data regarding young children with this disease. METHODS: We retrospectively studied 28 children diagnosed with EoE < 6 years of age who met criteria and were identified via ICD-9 code 530.13 in the electronic medical record. RESULTS: The average age at diagnosis was 2.8 years + 1.6 years. There were 21 males and 7 females: 43% had eczema, 39% had asthma, and 29% had allergic rhinitis. The most common presenting symptoms were vomiting (64%) and failure to thrive (43%). Milk allergy had been diagnosed in 39% of patients. Histopathology revealed a mean eosinophil count of 42 eosinophils/hpf in the mid esophagus and 63 eosinophils/hpf distally. Positive prick skin tests to at least one environmental antigen were seen in 39% of children and 64% had a positive prick skin test to at least one food allergen. The most common food allergens were egg white(75%) and soy(61%). Most common environmental allergens were tree pollen (32%), grass pollen (25%), and dust mite(25%). CONCLUSIONS: As reported in older children and adults, there is a high incidence of atopic disorders including eczema, asthma, food allergies, and allergic rhinitis in young children with EoE. The presence of atopy, along with vomiting or failure to thrive in young children, may be suggestive of EoE, and should prompt consideration for earlier diagnostic interventions. Additional studies of this population are needed to clarify the specific nature of the association between atopy and EoE.

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Presence of Food Allergy Alters the Presentation of Pediatric Eosinophilic Esophagitis

Barry J. Pelz, MD1, Joshua B. Wechsler, MD2, Anusha Reddy Gaddam, MS3, Katie Amsden, MPH4, Barry Wershil, MD2, Amir F. Kagalwalla, MD2, Paul Bryce, PhD5; 1Division of Allergy & Immunology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, 2Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, 3Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, 4Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 5Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 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 IgEmediated 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.

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