Eosinophilic Oesophagitis In Atopic Paediatric Population: Study Findings This retrospective study examined children diagnosed with EoE at Sheffield Children’s Hospital between 2020 and 2023. It explored the relationship between atopy, presenting symptoms, and response to treatment, particularly elimination diets. The findings suggest that patients with atopy are more likely to present with dysphagia and respond well to dietary management, though rare cases of post-elimination sensitisation were also observed. EOS Network is pleased to introduce William Fong, an FY1 doctor and early career researcher at Nottingham University Hospitals, with a paediatric allergy and gastroenterology background. William recently presented findings from a Sheffield Children's Hospital study, which he is now preparing for publication. His research explores Eosinophilic Oesophagitis (EoE), focusing on its phenotypes and treatment responses. The project was carried out in collaboration with gastroenterology and allergy consultants. Key Findings: More than 50% of the patients with EoE had at least one atopic comorbidity. Over 50% of the patients had at least one food allergy. Patients with both atopy and EoE were more likely to be female. Some atopic patients may develop new food sensitivities after elimination diets. Careful monitoring is needed. Please watch the presentation or read the written version below. Ask questions about the study or share your feedback. Background Eosinophilic Oesophagitis (EoE) is a chronic allergic inflammatory disorder of the oesophagus, presenting symptoms such as food regurgitation, reflux-like symptoms, pain when swallowing, and sometimes food bolus obstruction. In those cases, patients need ENT surgical removal. EoE is also linked to atopic comorbidities and food allergies. Common management strategies often begin with proton pump inhibitors (PPIs), followed by elimination diets and/or swallowed topical steroids such as oral viscous budesonide. Working in collaboration with gastroenterology and allergy teams helps identify any foods a patient may be sensitised to, and removing these from the diet can help determine whether symptoms improve. Dr William Fong, Nottingham University Hospitals: "We conducted this study because EoE is becoming more prevalent, yet limited research characterises patients with atopy and how it relates to their condition. Specifically, do they experience different symptoms or respond better to certain treatments? These are the questions we aimed to investigate." Methods This retrospective study reviewed children between the ages of 2 and 16 diagnosed with EoE at Sheffield Children's Hospital between 2020 and 2023. Inclusion criteria were EoE symptoms and histopathology showing ≥15 eosinophils per high-power field. The research excluded children with previous funding applications and patients with airway atresia. Following a discussion with the allergy and gastroenterology teams, we excluded certain patients to ensure a clear view of the oesophagus. The data collected for this study included sex distribution, age at diagnosis of EoE, presenting symptoms, and overlap with reflux. These parameters were first analysed across the whole patient group and then compared between those with atopy and those without to identify any differences. Overlap with reflux was defined as EoE with a reflux index greater than 4 on pH monitoring and/or a DeMeester score above 14.7. Treatment response was assessed based on histological remission - a reduction in eosinophil count to below 15 per high-power field, following treatment with proton pump inhibitors (PPIs), oral viscous budesonide, or elimination diets. Eosinophil counts were assessed at each follow-up endoscopy. Results The results show that more than half of the patients with EoE had at least one atopic comorbidity. The most common atopic comorbidity was allergic rhinitis (hay fever). The chart here displays each patient and highlights those with all three comorbidities. Dr. William Fong is presenting the study results, which highlight the presence of comorbidities. Over half of the patients had at least one food allergy. The most common was peanut allergy, followed by tree nut allergy (both are among the most common food allergens). When comparing patients with atopy to those without, a significant difference was observed in the male-to-female ratio: patients with both atopy and EoE were more likely to be female. For the other parameters, there were no significant differences, apart from one presenting symptom: dysphagia, which was more commonly reported in the atopic group. Patients with atopy were significantly more likely to present with dysphagia compared to those without atopy. Regarding treatment response, a key finding (also illustrated through a case study below) is that patients with atopy and EoE responded better to elimination diets, which aligns with expectations given their allergic profiles. These foods can trigger mast cell activation, so removing them, particularly in patients sensitised to specific allergens, can lead to more significant improvements. Our findings reflected this. The following case study highlights an important consideration when managing atopic patients undergoing elimination diets. Case Report Post Elimination Diet IgE-Mediated Food Sensatisation: a Case Report slide, presented by Dr W. Fong. One particularly interesting case involved a patient with atopy who began an elimination diet after being diagnosed with EoE at age six. He initially received oral viscous budesonide but did not respond to treatment. As a result, he was placed on an empirical elimination diet, excluding oats, milk, eggs, and soy. Within two years of starting the elimination diet, a follow-up endoscopy showed histological improvement, with eosinophil counts dropping below 15 per high-power field. However, the patient later developed a reaction to egg exposure, presenting with abdominal pain, vomiting, and diarrhoea. Allergy testing revealed elevated specific IgE levels to egg. His specific IgE level to egg was 2.47. He has been advised to continue avoiding eggs while awaiting an oral food challenge. This patient also had multiple atopic comorbidities, including allergic rhinitis and asthma. While cases like this are uncommon, Sheffield Children's Hospital consultants have observed one or two instances where an atopic patient developed sensitisation to a food after its elimination. Discussion Key discussion points from these findings include the significant difference in presenting symptoms, particularly dysphagia, between atopic and non-atopic patients with EoE. Patients with atopy are also more likely to respond to food-elimination diets. However, although rare, there are important cases where atopic patients may become sensitised to foods after eliminating them, highlighting the need for careful monitoring and follow-up. Ask questions about the study or share your feedback. To share your research, click here Authors: W. Fong, A. Manoj, S. Sharma, S. Sonmez-Ajtai, E. Minshall Affiliation: Sheffield Children’s Hospital Conflicts of Interest: The authors declare no conflicts of interest. Read similar publications: Eosinophilic Oesophagitis in the Atopic March: A Multidisciplinary Strategy for Atopic Diseases Understanding the Link Between Food Allergy and Atopic Dermatitis. Key Study Insights The Evolving Understanding of Eosinophilic-Associated Type 2 Inflammatory Diseases Manage Cookie Preferences