Food and aeroallergen sensitization in adult eosinophilic esophagitis

摘要

Eosinophilic esophagitis (EoE) is a disorder that has increased in prevalence and causes significant morbidity in children and adults.1 The diagnosis of EoE requires endoscopic demonstration of greater than 15 eosinophils per high-power field in at least 1 esophageal biopsy specimen.Although numerous studies have been published describing the clinicopathologic features of pediatric patients with EoE, fewer have reported findings in adult EoE patients. The objective of this study is to report the baseline clinical characteristics, endoscopic evaluation, and sensitization profile of adult patients with EoE.Patients were retrospectively selected based on the following study criteria: (1) Demonstration of a clinical history suggestive of EoE, (2) presence of 15 or more eosinophils/high-power field on esophageal biopsy, (3) age 18 years or older. All patients had been evaluated by a gastroenterologist and referred to the Allergy department with a diagnosis of EoE. Sixty-six eligible patients evaluated between January 2008 and December 2012 were included. Not all patients had baseline proton-pump inhibitor treatment data available. The protocol was approved by the Institutional Review Board of the Ohio State University Medical Center.Allergy evaluation included atopic and diet histories. Food allergy was defined by a clinical history of IgE-mediated symptoms (e.g., hives, angioedema, anaphylaxis) and positive allergy testing. No oral food challenges were performed. Immediate hypersensitivity was evaluated by skin prick testing (SPT) to a panel of food and environmental allergens using a Greer pick with commercially available extracts (Greer Laboratories, Inc, Lenoir, North Carolina). The standard food panel included egg, milk, wheat, soy, peanuts, tree nuts, fish, and shellfish. In select patients, when guided by clinical history, other foods were tested to include other legumes, grains, meats, vegetables, and fruits. A standard panel of environmental allergens included pollens, molds, dust mite, cat, and dog. Skin prick responses with wheal sizes 3 mm or larger than the negative control were considered positive.Fisher's exact method was used to test differences in categorical variables, and the Wilcoxon rank-sum procedure was used in continuous variables. Exact logistic regression was used to estimate odds ratios.