PURPOSE OF THE STUDY.
Eosinophilic esophagitis (EoE) is often associated with atopic/allergic disorders. Seasonality has been established in the diagnosis of eosinophilic esophagitis, but there are limited data to support the contribution of aeroallergens to the development of EoE. This pilot study was designed to determine whether there is a seasonal variation in the onset of symptoms and/or diagnosis of EoE and whether these variations correlate with a specific pollen concentration within New York City.
All pediatric patients ages 0 to 21 years old diagnosed with EoE by histologic diagnosis between 2002 and 2012 at New York-Presbyterian/Weill Cornell Medical Center. Histologic diagnosis was defined as >15 eosinophils per high-powered field on esophageal biopsies after treatment for 6–8 weeks with a proton pump inhibitor.
Retrospective chart review of EoE pediatric patients assessed for date of initial symptoms as identified by the pediatric patient and parental recall and date of histologic diagnosis. Demographic data, including sex, ethnicity, concomitant atopic disorders, and residential county, were obtained. Atmospheric pollen was collected using a Burkard volumetric spore trap from 2009 to 2012, and the data were examined for 11 taxa: Acer (maple), Betula (birch), Populus (poplar), Ulmus (elm), Quercus (oak), Carya (hickory), Fraxinus (ash), Platanus (sycamore, London planetree), Fagus (beech), Poaceae (grass pollen family), and Ambrosia (ragweed). To assess seasonal deviations in the distribution of observed EoE patients diagnosed, the binomial test was used to compare observed results with a theoretically expected distribution. Spearman rank correlation coefficient was used to assess the correlation between peak allergen count and onset of EoE.
Sixty-six patients were identified and classified by the date of initial symptoms and date of histologic diagnosis. There was a seasonal variation in the onset of symptoms and diagnosis of EoE, with the highest number of patients reporting onset of symptoms of EoE from July to September and with diagnosis being made in the next season (October to December). There was a seasonal correlation between peak levels of grass pollen and peak onset of EoE symptoms, which were both highest from July to September.
The data suggest that there is a correlation between specific aeroallergen levels and both the onset of symptoms and time of diagnosis of patients with EoE in New York City.
The strength of this study is that it identifies a correlation between aeroallergen exposure with symptoms and diagnosis in pediatric EoE. The limitations of this study include the significant variability in the length of time between the initial onset of symptoms of EoE and the date of diagnosis of EoE as well as the retrospective nature of the data collection. The possibility of inaccurate patient recall of month or season of symptom onset is likely. In addition, the pollen counts were collected in 2009, a full 7 years after some of the patient samples were collected. The pollen counts may have changed over this decade.
- Copyright © 2017 by the American Academy of Pediatrics