Background: In children with eosinophilic esophagitis (EoE) foods are the most common disease triggers, but environmental allergens are also suspected culprits.
Objective: To determine the effects of environmental allergen sensitization on response to treatment in children with EoE in the southeastern United States.
Methods: Patients 2 to 18 years old who were referred to the Arkansas Children’s Hospital Eosinophilic Gastrointestinal Disorders Clinic from January 2012 to January 2016 were enrolled in a prospective, longitudinal cohort study with collection of demographics, clinical symptoms, medical history, allergy sensitization profiles, and response to treatment over time. Comparisons were made between complete responders (peak esophageal eosinophil count < 15 per high-power field [HPF]) and nonresponders (> 25 eosinophils per HPF) after treatment with diet elimination alone, swallowed corticosteroids alone, or diet elimination and swallowed corticosteroids. Sensitization patterns to environmental allergens found in the southeastern United States were analyzed for the effect on treatment response.
Results: A total of 223 individuals were enrolled. Of these, 182 had environmental allergy profiling and at least one endoscopy while receiving proton pump inhibitor (PPI) therapy. Twenty-nine individuals had PPI-responsive EoE and were excluded from further analysis, leaving 123 individuals with none-PPI-responsive EoE who were further analyzed; 72 (58.5%) were complete responders and 33 (26.8%) were nonresponders. Seventeen individuals (13.8%) were partial responders (≥ 1 but ≤ 25 eosinophils per HPF) and excluded from further analysis. Nonresponders were more likely to be sensitized to perennial allergens (P = .02). There was no significant difference in response based on seasonal allergen sensitization. Individuals with mold or cockroach sensitization were more likely to fail combination diet and swallowed corticosteroid treatment (P = .02 and P = .002).
Conclusion: Perennial allergen and mold sensitization may lead to nonresponse to EoE treatment in some patients. Additional studies are needed to further understand the effect of environmental allergens on EoE.
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We thank the Claudia and Steve Strange Family Fund for their generous financial support of the Arkansas Children’s Hospital Eosinophilic Gastrointestinal Disorders Program.
Support for this project was provided through research training grant U54 AI117804 as part of the Consortium of Eosinophilic Gastrointestinal Researchers. The Consortium of Eosinophilic Gastrointestinal Researchers is part of the Rare Disease Clinical Research Network, an initiative of the Office of Rare Diseases Research, National Center for Advancing Translational Sciences, and is funded through collaboration between National Institute of Allergy and Infectious Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, and National Center for Advancing Translational Sciences.
Pesek, Robert D.; Rettiganti, Mallikarjuna; O'Brien, Erin; Beckwith, Sarah; Daniel, Caroline; Luo, Chunqiao; Scurlock, Amy M.; Chandler, Peggy; Levy, Rebecca A; Perry, Tamara T.; Kennedy, Joshua L.; Chervinskiy, Sheva; Vonlanthen, Maryelle; Casteel, Helen; Fiedorek, Stephen C.; Gibbons, Troy; and Jones, Stacie M., "Effects of Allergen Sensitization on Response to Therapy in Children with Eosinophilic Esophagitis" (2017). Pediatrics Faculty Publications. 296.