Presentation, clinical approach to eosinophilic esophagitis different for adult, pediatric patients

Eosinophilic esophagitis presents and is approached differently among children than in adults, according to data from studies presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting in San Antonio.

In one retrospective study, researchers evaluated 31 children, aged 2 to 18 years, and adults with biopsy-proven eosinophilic esophagitis (EoE), and compared their disease characteristics. Investigators noted no significant differences between patients regarding incidence of concurrent allergic rhinitis (62% of adults vs. 64.5% of children), eczema (8% vs. 26%) or asthma (27% vs. 48%), or family history of atopy (46% vs. 61%).

Differences in clinical presentation, however, were observed. Dysphagia was more common among adults (76% of cases vs. 29%; P<.05), while children presented more frequently with abdominal pain (29% vs. 8%; P<.05).

In a second retrospective study, researchers compared clinical approaches to adult and pediatric patients with EoE by assessing a cohort of 195 adults and 50 children who responded to a questionnaire regarding presentation, evaluation of their allergies and treatment response.

Pediatric patients were referred to allergists more often (70% of children vs. 39% of adults), and IgE related to specific foods was measured more frequently (66% vs. 16%) than in adults (P<.0001 for both). Children also received food-related patch (20% vs. 1%; P<.0001) and skin prick tests (36% vs. 25%) more frequently, and dietary therapy was suggested more frequently for them (61% vs. 23%; P<.0001).

Researchers said these different approaches occurred despite similar incidence of allergic rhinitis (48% of children vs. 44% of adults; P=.6) and sensitization positivity indicated via IgE measurement (73% vs. 68%) and skin prick testing (56% vs. 67%), as well response rates to dietary therapy.

A third study included data from 457 pediatric patients diagnosed with EoE. Demographic data, symptoms and comorbidities were assessed, and monthly exposure to mold spores and tree, grass and weed pollen was determined.

Among 81 clinico-pathologic cases, similar numbers of patients were diagnosed during seasons of high tree (January through May, 30.8%) grass (February through June, 33.3%) and weed (August through November, 37%) pollen counts, with 13.5% diagnosed out of season.

“Studies in the adult population suggest seasonal variation in the diagnosis of EoE due to seasonal aeroallergens, but there is no evidence of this in the pediatric population,” the researchers wrote. “EoE diagnoses in this pediatric population were evenly distributed throughout the year.”

For more information:

Schlegel CR. #635: Perennial Distribution of Pediatric Eosinophilic Esophagitis Diagnoses. Presented at: The American Academy of Allergy, Asthma & Immunology Annual Meeting; Feb. 22-26, San Antonio.

Vernon N. #638: Comparison of Atopic Features Between Children and Adults with Eosinophilic Esophagitis. Presented at: The American Academy of Allergy, Asthma & Immunology Annual Meeting; Feb. 22-26, San Antonio.

Vatti RR. #639: Eosinophilic Esophagitis: A Comparison of Clinical Approaches Towards Pediatric and Adult Patients in a Large HMO. Presented at: The American Academy of Allergy, Asthma & Immunology Annual Meeting; Feb. 22-26, San Antonio.