Eosinophilic esophagitis associated with increased number, severity of food allergies
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Key takeaways:
- Patients with a greater number of food allergies were 1.3 times more likely to have eosinophilic esophagitis.
- Patients with more frequent allergic reactions were 1.2 times more likely to have EoE.
Patients with food allergies and eosinophilic esophagitis have more food allergies, more allergic reactions and increased reaction severity, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.
These differences may indicate a more severe food allergy phenotype, Katherine M. Guarnieri, MD, pediatrician, department of pediatrics, University of Cincinnati College of Medicine, and colleagues wrote.
The researchers consulted data from 6,074 patients with food allergy enrolled in the Food Allergy Research & Education (FARE) Patient Registry, compiled between May 2017 and December 2020. These patients completed the 44-item Food Allergy History Survey. Also, 4,676 of these patients completed the 61-item Food Allergy Reactions Survey as well.
Patients ranged in age from younger than 1 year to older than 80 years, with a mean age of 19.46 years (standard deviation, 18.49) and median of 13 years. The cohort also was 57% female, with 95% living in the United States. Demographics included 83% white, 7% multiracial, 4% Asian and 3% Black, and 7% identified as Hispanic or Latino.
Five percent of these patients had coexisting EoE (+EoE). There was no significant difference in the current age at the time of the survey or in age at time of food allergy diagnosis between the +EoE patients and those who did not have EoE (–EoE), the researchers said. Also, while 52% of the +EoE patients and 57% of the –EoE patients were female, the researchers did not consider this difference significant.
A multivariable logistic regression model, however, found that male patients were 1.3 times more likely than female patients to have EoE (95% CI, 1.04-1.72). This model also found that Asian patients were less likely to report EoE than White patients (adjusted OR = 0.24; 95% CI, 0.078-0.77).
Further, patients with a parent or sibling with a food allergy were 2.1 times more likely to have coexisting EoE (95% CI, 1.63-2.66). Patients with allergic or immune-mediated comorbidities had higher odds for EoE as well.
Specifically, adjusted odds ratios included 2 for asthma (95% CI; 1.55-2.49), 1.8 for allergic rhinitis (95% CI, 1.37-2.22), 2.8 for oral allergy syndrome (95% CI, 2.09-3.7), 2.5 for food protein-induced enterocolitis syndrome (95% CI, 1.34-4.84) and 7.6 for hyper-IgE syndrome (95% CI, 2.93-19.92).
The researchers said there was no significant difference in comorbid atopic dermatitis (aOR = 1.3; 95% CI, 0.99-1.59), although arrhythmias, migraines and other nonatopic conditions were associated with EoE.
In fact, only one patient with EoE did not have any other comorbidities in addition to food allergy, compared with 478 patients who did not have EoE nor any additional comorbidities (aOR = 0.037; 95% CI, 0.0052-0.26).
The most frequently reported allergens of the 14 allergens examined among the +EoE and –EoE groups alike were peanut, tree nuts, eggs and milk. Peanut was the only allergen that did not have any significant association with EoE (aOR = 1.1; 95% CI, 0.87-1.47). Patients with higher numbers of food allergies, meanwhile, were 1.3 times more likely to have EoE (95% CI, 1.23-1.32).
The highest adjusted odds ratios for EoE included 2 for milk allergy (95% CI, 1.49-2.62), 1.6 for finned fish (95% CI, 1.16-2.29), 1.4 for soy (95% CI, 1.05-1.88), 1.6 for meat (95% CI, 1.12-2.22) and 1.6 for “other” (95% CI, 1.28-2.12).
The patients with more frequent allergic reactions related to their food allergy each year were more likely to have EoE as well (aOR = 1.2; 95% CI, 1.11-1.24). Similarly, –EoE patients were more likely to report that they never have had an allergic reaction related to their food allergy.
There also were significantly higher likelihoods for having EoE among patients who have had anaphylaxis (aOR = 1.5; 95% CI, 1.15-1.83) or used acute health care services such as urgent care, the ED, the hospital or an ICU (aOR = 1.3; 95% CI, 1.01-1.67) for their reaction, the researchers said.
Patients who reported gastrointestinal, autonomic or motor symptoms within 2 hours of eating their allergen were more likely to have EoE, whereas –EoE patients were more likely to report cutaneous symptoms.
The +EoE and –EoE patients did not report any differences in ever using intramuscular (aOR = 0.95; 95% CI, 0.7-1.28) or intravenous (aOR = 1.4; 95% CI, 0.95-1.99) epinephrine to manage their allergic reactions.
Finally, the researchers reported that 34% of the +EoE group and 29% of the –EoE group outgrew a food allergy, but they did not consider this difference to be statistically significant.
Overall, the researchers said, patients with greater numbers of food allergies, greater frequency of food-related allergic reactions, and increased measures that reflect reaction severity have greater odds for EoE, possibly signifying more severe systemic disease.
Using this information, the researchers continued, providers may be better able to manage their patients’ EoE, tailor how they counsel patients and their families, anticipate increased health care needs and ideally optimize care for each individual patient.
Perspective
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Jennifer Bufford, MS, CRQM, CCRP, CCRC
While it has been reported in the literature that 70% of EoE patients also have a food allergy, this study suggests that EoE is associated with increased food allergies, food-related reactions and measures of reaction reflective of severity such as a history of systemic symptoms and health care utilization for food-related allergic reactions.
In other words, individuals with a greater number of food allergies, more severe and frequent food-related allergic reactions, and increased health care utilization for these reactions are more likely to have EoE.
The study also found that individuals with EoE are more likely to also have a diagnosis of asthma, oral allergy syndrome, food protein-induced enterocolitis syndrome and other atopic conditions. The odds of EoE were significantly higher in patients with an allergy to milk, finned fish, soy and meat.
Physicians can use these findings to inform their evaluation and management of patients with EoE and anticipate the potential increased health care needs. Still, the interplay of EoE and food allergies is incompletely understood. Further study of the characterization of food allergy in patients with EoE is warranted.
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