A study published in the Annals of Allergy, Asthma and Immunology has found a correlation in children with an IgE-mediated food allergy (IgE-FA) reporting symptoms of eosinophilic oesophagitis (EoE).

The masking of symptoms, disease underrecognition, and the need for an invasive diagnostic procedure makes EoE difficult to diagnose and it is often a delayed process.

The aim of this study was to determine the extent to which children with IgE-FA (but without a diagnosis of EoE) reported EoE symptoms through formal screening.

The correlation lead researchers to conclude that screening patients with an IgE food allergy may be beneficial.

Study

After exclusions, 223 children aged 8-18 or parents who proxied for children aged 2-18 with IgE-FA were surveyed using the Pediatric Eosinophilic Esophagitis Sympton Severity Module (PEESS) over 6 months. All were asked a supplementary question "do you ever feel food going down after swallowing?"

13 of these patients with IgE-FA also had diagnoses of EoE, and were included for comparison.

Primary outcome

The primary outcome was patients who scored the frequency of dysphagia-related symptoms as ≥1 per week with severity of "kind of bad" or worse and answered "yes" to the supplementary question.

Overall, 24% of participants with IgE-FA and without diagnosed EoE had a positive response.

Secondary outcomes

One secondary outcome was positive responses to non-dysphagia PEESS items. 90% of patients who met the co-primary endpoints reported at least 1 positive non-dysphagia PEESS item.

Another secondary outcome was correlation between child and parent responses. Only 9 of the parent and child responses correlated. When a child without diagnosed EoE gave a positive dysphagia response, 57% of their parents gave a negative response.

Limitations

There was no control group, and no endoscopy afterwards to diagnose EoE in those that gave a positive response. Dysphagia scores on the PEESS may not differentiate EoE and non-EoE patients.

The study was intended as a baseline for future studies, and alongside the results it should be noted that EoE can be asymptomatic over time.

Conclusions

The study found that children with IgE-FA have high reported rates of dysphagia. Authors Peter Capucilli, Allison Ramsey, Linh-An Tuong and S. Shahzad Mustafa commented:

It is necessary to evaluate these patients histologically, but these findings may serve as foundation for formal screening recommendations in the future.

Links

• 'Should children with IgE-mediated food allergy be screened for eosinophilic esophagitis?' in AAAI
• Summary in American Journal of Managed Care
• 'Allergy & EoE - What's the connection?' webinars