PURPOSE OF THE STUDY.
To determine the degree of allergic sensitization in patients with eosinophilic esophagitis by using serum immunoglobulin E (IgE) testing and comparing the results to those obtained by epicutaneous skin-prick tests (SPTs) and patch testing.
This was a cross-sectional study of pediatric patients (N = 53) referred for evaluation for biopsy-proven eosinophilic esophagitis at an allergy referral clinic at Nationwide Children's Hospital (Columbus, OH) over a 2½-year period (January 2007 to June 2009).
Questionnaires about symptoms and treatment of eosinophilic esophagitis were completed. Serum-specific IgE antibodies to 8 common foods and 8 inhalants were measured. Epicutaneous SPTs were performed to 16 foods and 38 inhalant allergens. Patch testing to foods was also performed. IgE-mediated allergy was diagnosed if either serum-specific IgE or skin-prick test results were positive, whereas non–IgE-mediated allergy was diagnosed if a positive patch test result was found. A streptavidin-based immunoassay was performed to determine the presence of cross-reactive carbohydrate determinants and Helicobacter pylori.
Prevalence of food and inhalant allergy was 80%. The most common symptoms were dysphagia, vomiting, and abdominal pain. Food-specific IgE test results were positive to food more often than were SPT results, most commonly to milk. Serum-specific IgE detected sensitization to food in 42% of patients without a diagnosis of food allergy. Food and inhalant allergies were found with similar frequencies. Almost one-third of patients had multiple sensitivities (tree nuts, peanut, pollen, soy, and grains). Recent studies revealed allergy to plant and mammalian-derived cross-reactive carbohydrate determinants, and 3 patients were found to have a positive result (2 to bromelain and 1 patient to galactose-α-1,3-galactose). Patch-testing results were positive for more than one-third of the patients, most commonly to rye, without correlation to either serum-specific IgE or SPT results.
The majority of patients with eosinophilic esophagitis are atopic. The use of serum-specific IgE to foods might be useful, in particular to milk.
The treatment of patients with eosinophilic esophagitis is challenging. The authors found that almost half of the patients were identified to have sensitization to a previously undiagnosed food allergen. Although the clinical significance of the serum-specific IgE might be argued, elimination diets for most patients with eosinophilic esophagitis leads to improvement. This study provides insight into another diagnostic modality, frequently used in the diagnosis of other allergic conditions, that might aid clinicians in the diagnosis and treatment of patients with eosinophilic esophagitis. However, more correlation with response to elimination of specific foods is needed.
- Copyright © 2011 by the American Academy of Pediatrics