Atopic conditions increase risk of future pediatric eosinophilic esophagitis

Eosinophilic esophagitis is most likely to be experienced by children after atopic dermatitis, food allergy or asthma, with statistical concurrence with allergic rhinitis, according to a study presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology in Orlando.

Although atopic dermatitis, food allergy and asthma are risk factors for future eosinophilic esophagitis (EoE), the researchers also observed that children who experience EoE are at increased risk of developing allergic rhinitis.

“The cumulative risk of EoE also went up with each subsequent atopic, or allergic, disease,” Jonathan M. Spergel, MD, PhD, FAAAAI, chief of the allergy section at Children's Hospital of Philadelphia, said in a press release. “Our findings indicate that EoE falls into the pattern of atopic march, although EoE tends to be diagnosed later in the progression.”

To explore the association between EoE and the progression of allergic diseases, Spergel and colleagues conducted a case-control analysis that included a cohort of children that were recruited before reaching 1 year of age. Follow-up was conducted for at least 24 months.

The researchers used score-matched controls to determine whether atopic dermatitis, food allergy or allergic rhinitis alter a child’s risk for developing EoE.

Of the 130,457 children included in the analysis, 139 developed EoE, with the researchers observing a prevalence of 0.11%. Infants who were male (OR = 2.7; 95% CI, 1.9-4.0) and/or white (OR = 2.4; 95% CI, 1.5-3.9) were more likely to develop the condition. EoE was diagnosed at a peak age of 2.7 years, whereas diagnoses for atopic dermatitis were normally made at 0.4 year, food allergy at 1 year, asthma at 1.1 years and allergic rhinitis at 4.1 years.

Atopic dermatitis, food allergy and asthma were independent risk factors for subsequent EoE diagnosis (atopic dermatitis: HR = 2.7; 95% CI, 1.9-4.0; food allergy: HR = 8.9; 95% CI, 6.3-12.4; asthma: HR = 2.2; 95% CI, 1.6-3.1). When a child was diagnosed with EoE, they were at greater risk of later allergic rhinitis diagnosis (HR = 3.8; 95% CI, 1.4-2.7). <

Furthermore, the risk of EoE was substantially increased based on the cumulative effect of one atopic condition (HR = 3.9; 95% CI, 2.6-5.7), two conditions (HR = 6.5; 95% CI, 4.3-9.9), three conditions (HR = 9.8; 95% CI, 5.8-16.8) or four conditions (HR =12.2; 95% CI, 5.0-30.0).

“Infants with [atopic dermatitis] are more likely to be diagnosed with food allergy or asthma when they are about a year-old,” Spergel said. “If a child was diagnosed with all three conditions, they are even more likely to develop EoE than if they only had one or two other conditions.” – by Katherine Bortz

Reference:

Hill DA, et al. Abstract 274. Presented at: American Academy of Allergy, Asthma & Immunology Annual Meeting; March 2-5, 2017; Orlando.

Disclosure: Infectious Diseases in Children was unable to confirm relevant financial disclosures prior to publication.