Demographic, Clinical, and Allergic Characteristics of Children with Eosinophilic Esophagitis in Isfahan, Iran
Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease isolated to the esophagus Food allergy is thought to play an important role in the pathophysiology of EOE. The aim of this study is to evaluate demographic features and sensitivity of patients with reference to common food allergens. Children with documented EoE were enlisted for this study. Skin prick test and patch test were done for all participants. Each test contained common food allergens. Other tests, such as evaluation of total IgE and eosinophil count, were also done. A total of 30 patients (the mean age of participants was 3±6 years) with 6 months to 15 years documented EoE participated in this study. The mean duration of symptoms was 2 years. Association with other allergic disorders was seen in 16 (32%) patients [Asthma in 8 (26.7%), allergic rhinitis in 5 (16.7%) and eczema in 3 (10%)]. The mean level of total IgE was 413.5±505.5 (IU/ML): total IgE level was above normal range for age in 17 children. The mean level of eosinophil was 372.2±305.2, and eosinophilia was seen in 11 patients (36.7%). The skin prick test and patch test findings showed that 28 patients (93%) and 17 of 30 patients (56.6%) tested positive to foods respectively. The most common positive skin prick test was for sesame and walnut. Patch test showed that the most common positive test was for fish. Evaluating the symptoms indicated that vomiting (70%) is the most prevalent symptom in patients; the less prevalent symptom was dysphagia (3.3%). Other prevalent symptoms were subsequent abdominal pain (33.3%), gaining weight failure (33.3%), heartburn (16.6%), cough (10%), fecal impaction (10%), and constipation (6.66%). Our series confirms the high degree of atopy in Iranian children with EoE. These patients seem to be polysensitized to several food allergens Because of different eating cultures in different countries, considering special food in selecting allergens for allergic tests is needed.
2. Sampson HA, Anderson JA. Summary and recommendations: classification of gastrointestinal manifestations due to immunologic reactions to foods in infants and young children. J PediatrGastroenterolNutr 2000; 30(1):S87-S94.
3. Khan S, Orenstein SR, Di Lorenzo C, Kocoshis SA, Putnam PE, Sigurdsson L, et al. Eosinophilic esophagitis: strictures, impactions, dysphagia. Dig Dis Sci 2003; 48(1):22-9.
4. Desai TK, Stecevic V, Chang C-H, Goldstein NS, Badizadegan K, Furuta GT. Association of eosinophilic inflammation with esophageal food impaction in adults. Gastrointest Endosc 2005; 61(7):795-801.
5. Straumann A, Spichtin H-p, Grize L, Bucher KA, Beglinger C, Simon H-u. Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. Gastroenterology 2003; 125(6):1660-9.
6. Gonsalves N, Policarpio-Nicolas M, Zhang Q, Rao MS, Hirano I. Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis. Gastrointest Endosc 2006; 64(3):313-9.
7. Roy-Ghanta S, Larosa DF, Katzka DA. Clin Gastroenterol Hepatol. 2008 May;6(5):531-5. doi: 10.1016/j.cgh.2007.12.045. Epub 2008 Mar 4. Atopic characteristics of adult patients with eosinophilic esophagitis.
8. Elizabeth A Erwin, Hayley R James, Heather M Gutekunst, John M Russo, Kelly J. Kelleher, and Thomas A.E. Platts-Mills. Serum IgE measurement increases detection of food allergy among pediatric patients with eosinophilic esophagitis. Ann Allergy Asthma Immunol 2010; 104(6): 496–502.
9. Kelly KJ, Lazenby AJ, Rowe PC, Yardley JH, Perman JA, Sampson HA. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology 1995; 109(5):1503-12.
10. Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007; 133(4):1342–63.
11. Villarín AJL, de Rezende L. Esofagitiseosinofílica. Revisión de los conceptos fisiopatológicos y clínicos actuales. Gastroenterología y hepatología. 2007;30(4):234-43.
12. Mishra A, Hogan SP, Brandt EB, Rothenberg ME. An etiological role for aeroallergens and eosinophils in experimental esophagitis. J Clin Invest 2001; 107(1):83-98.
13. Lieberman JA, Sicherer SH. Diagnosis of food allergy: epicutaneous skin tests, in vitro tests, and oral food challenge. Curr Allergy Asthma Rep 2011; 11(1):58–64.
14. Liacouras CA, Wenner WJ, Brown K, Ruchelli E. Primary eosinophilic esophagitis in children: successful treatment with oral corticosteroids. J Pediatr Gastroenterol Nutr 1998; 26(4):380-5.
15..Dalal I, Zangen T, Shaoul R, Levine A. Presentation of Eosinophilic Esophagitis as Failure to Thrive in Young Children. Journal of Allergy and Clinical Immunology. 2010;125 (2):AB166.
16. Teitelbaum JE, Fox VL, Twarog FJ, Nurko S, Antonioli D, Gleich G, et al. Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate. Gastroenterology 2002; 122(5):1216-25.
17. Spergel JM, Beausoleil JL, Mascarenhas M, Liacouras CA. The uses of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol 2002; 109(2):363-8.
18. Attwood SE, Smyrk TC, Demeester TR, Jones JB. Esophageal eosinophilia with dysphagia. Dig Dis Sci 1993; 38(1):109-16.
19. Markovitz JE, LiacourasCA. Eosinophilic esophagitis. Gastroenterol Clin North Am 2003; 32(3):949–66
20. Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, et al. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006; 4(9):1097-102.
21. Kagalwalla AF, Amsden K, Shah A, et al. Cow’s milk elimination: a novel dietary approach to treat eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 2012; 55(6):711–6
22. Lucendo AJ, Arias Á, González-Cervera J, Yagüe-Compadre JL, Guagnozzi D, Angueira T, et al. Empiric 6-food elimination diet induced and maintained prolonged remission in patients with adult eosinophilic esophagitis: a prospective study on the food cause of the disease. J Allergy ClinImmunol 2013; 131(3):797-804.
23. Wechsler JB, Schwartz S, Amsden K, Kagalwalla AF. Elimination diets in the management of eosinophilic esophagitis. J Asthma Allergy 2014; 7:58-94.
24. Arias A, Gonzalez-Cervera J, Tenias JM, Lucendo AJ. Efficacy of dietary interventions in inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta-analysis. Gastroenterology 2014; 16(7):1639-48.
25. Spergel JM, Andrews T, Brown-Whitehorn TF, Beausoleil JL, Liacouras CA. Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests. Ann Allergy Asthma Immunol 2005; 95(4):336–43.
26. Pelz BJ, Wechsler JB, Amsden K, Johnson K, Singh AM, Wershil BK, et al. IgE-associated food allergy alters the presentation of paediatric eosinophilic esophagitis. Clin Exp Allergy 2016; 46(11):1431-40.
27. Rezende ER, Barros CP, Ynoue LH, Santos AT, Pinto RMC, Segundo GR. Clinical characteristics and sensitivity to food and inhalants among children with eosinophilic esophagitis. BMC research notes 2014; 7:47.
28. Straumann A, Spichtin HP, Grize L, Bucher KA, Beglinger C, Simon HU. Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. Gastroenterology 2003; 125(6):1660-9.
29. Spergel JM, Shuker M. Nutritional management of eosinophilic esophagitis. Gastrointestinal endoscopy clinics of North America 2008; 18(1):179-94.
30. Dalal I, Zangen T, Shaoul R, Levine A. Presentation of Eosinophilic Esophagitis as Failure to Thrive in Young Children. Journal of Allergy and Clinical Immunology. 2010; 125 (2):AB166.