Format

Send to

Choose Destination
J Allergy Clin Immunol Pract. 2018 Sep - Oct;6(5):1528-1533. doi: 10.1016/j.jaip.2018.05.010. Epub 2018 Jun 25.

Eosinophilic Esophagitis Is a Late Manifestation of the Allergic March.

Author information

1
Institute for Immunology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Department of Pediatrics, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa. Electronic address: hilld3@email.chop.edu.
2
Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pa.
3
Institute for Immunology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Department of Pediatrics, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa.

Abstract

BACKGROUND:

The allergic march describes the natural history of allergic conditions as they develop during childhood. Eosinophilic esophagitis (EoE) is a chronic allergic inflammatory disease that can be triggered by specific foods. Despite its allergic pathophysiology, the epidemiologic relationship between EoE and established members of the allergic march is unknown.

OBJECTIVE:

We sought to determine whether EoE meets epidemiologic criteria for being considered a member of the allergic march.

METHODS:

Using a primary care birth cohort of 130,435 children, we determined the natural histories of atopic dermatitis (AD), IgE-mediated food allergy (IgE-FA), asthma, EoE, and allergic rhinitis (AR) in individual patients. We then performed case-control analyses to establish the extent that existing allergic conditions influence the rate of subsequent EoE diagnosis.

RESULTS:

A total of 139 children developed EoE during the observation period (prevalence of 0.11%). The peak age of EoE diagnosis was 2.6 years, as compared with 0.3 years, 1 year, 1.1 years, and 2.1 years for AD, IgE-FA, asthma, and AR, respectively. The presence of AD (hazard ratio [HR] 3.2, 95% confidence interval [CI] 2.2-4.6), IgE-FA (HR 9.1, 95% CI 6.5-12.6), and asthma (HR 1.9, 95% CI 1.3-2.7) was independently and cumulatively associated with subsequent EoE diagnosis. The presence of AR was associated with subsequent EoE diagnosis (HR 2.8, 95% CI 2.0-3.9), and the presence of EoE was associated with subsequent AR diagnosis (HR 2.5, 95% CI 1.7-3.5).

CONCLUSIONS:

Allergic comorbidities are positively associated with EoE diagnosis. Together, our findings suggest that EoE is a late manifestation of the allergic march.

KEYWORDS:

Allergic march; Allergic rhinitis; Asthma; Atopic dermatitis; Eosinophilic esophagitis; Food allergy

PMID:
29954692
PMCID:
PMC6131029
DOI:
10.1016/j.jaip.2018.05.010
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center