Atopic diseases associated with greater risks for eosinophilic esophagitis in childhood

Key takeaways:

• The researchers used data from patients aged 1 to 18 years in the TriNetX Collaborative Network.
• Early diagnosis and treatment of atopic conditions may prevent EoE complications.

BOSTON — Children with atopic disease had increased risks for developing eosinophilic esophagitis, according to an abstract presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

Children with food allergy had the greatest risk for developing EoE, Catherine Haber, MD, PGY-3 pediatrics resident at Penn State Health Children’s Hospital, and colleagues wrote.

“We know that eosinophilic esophagitis patients tend to be atopic as well. However, we were interested to see if there was a predominant atopic condition that was associated with EoE,” Haber told Healio.

Catherine Haber, MD

The researchers examined data from children aged 1 to 18 years in the TriNetX US Collaborative Network, including children diagnosed with asthma (mean age, 13 years), allergic rhinitis (mean age, 12 years), atopic dermatitis (mean age, 12 years) or food allergy (mean age, 6 years) between 2016 and 2018 as well as children who did not have any of these diagnoses.

“We used the TriNetX database to conduct a real-world study to examine the risk of each atopic condition subsequently developing EoE,” Haber said. “There was a slight male predominance in each of the cohorts.”

Also, Haber said, most patients in each cohort were white, followed by Black or African American.

The study included 1,885 of 718,976 patients with asthma and 726 of 720,734 control patients who developed EoE (HR = 2.35; 95% CI, 2.16-2.56).

It also included 1,444 of 647,872 patients with allergic rhinitis and 829 of 649,601 control patients who developed EoE (HR = 1.45; 95% CI, 1.34-1.58).

Additionally, 533 of 200,155 patients with AD and 307 of 200,592 control patients developed EoE (HR = 1.53; 95% CI, 1.33-1.76).

The food allergy group included 1,098 of 126,354 patients with a food allergy and 166 of 128,724 control patients who developed EoE (HR = 6.31; 95% CI, 5.36-7.43).

“We were surprised that food-allergic patients had a higher risk of developing EoE compared to the other atopic conditions,” Haber said.

Based on these findings, the researchers concluded that there were associations between atopic diseases and increased risks for developing EoE.

“Patients who develop EoE have been noted to have comorbid atopic conditions. However, having an atopic history is not required to develop EoE,” Haber said.

“Unfortunately, while our knowledge regarding the underlying pathophysiology in EoE has grown considerably, there is still a lot of work to be done to connect specific atopic conditions to EoE,” she continued.

Haber added that an immunologic trigger shared among these atopic conditions probably causes EoE in predisposed individuals and that all doctors who care for atopic patients should keep EoE on the differential, particularly in younger children whose symptoms may be more subtle.

“Food allergy patients are at higher risk compared to patients with other atopic conditions of developing EoE. Early diagnosis and treatment of this condition will help to prevent complications of EoE, some of which have long-term health implications,” Haber said.

“Further research is needed to help clarify the connection between atopic conditions and EoE to determine why some atopic patients develop EoE and others do not,” she said.

Reference:

• Risk of developing EoE high when other allergic conditions factored in. Published Oct. 24, 2024. Accessed Oct. 24, 2024.

For more information:

Catherine Haber, MD, can be reached at murray61122@gmail.com.