High Incidence of Atopy in Young Children with Eosinophilic Esophagitis

Abstract

RATIONALE: To assess clinical and demographic characteristics of children with eosinophilic esophagitis (EoE) in a new multidisciplinary allergy and gastroenterology clinic serving British Columbia. METHODS: Children referred to the BC Children's Hospital EoE clinic with biopsy-proven EoE were approached to join our longitudinal EoE registry. After parents consented, data on clinical characteristics and management were recorded. Descriptive statistics and Mann-Whitney Utests examined differences between groups given that our data was not normally distributed. RESULTS: Among 63 patients assessed between July/2012 and August/ 2014, the majority (84%) were male, and median age at diagnosis was 5.8 years (IQR56.6). Forty-six percent (29) had allergy testing previously, 41% (26) had immediate food allergy (among those 17% had more than 1 food trigger and 46% (12) had experienced anaphylaxis.) Almost one-third (29%) had atopic dermatitis, 29% had allergic rhinitis, and 24% had asthma. Most were white (71%) or South Asian (25%). Among 19 (30%) patients on dietary intervention for EoE, cow's milk (32%) and egg (21%) were the most commonly restricted foods. Most (62%) were from the Vancouver area where median time from symptom onset to diagnosis was 1.3 years (IQR51.1) versus 2.8 years (IQR54.5) for those outside the Vancouver area (p<0.05). CONCLUSIONS: This is the first EoE registry that we are aware of in Canada. The underlying factors for longer delays outside the Vancouver area need to be further explored in order to evaluate the potential need for improved EoE service access outside of the Vancouver area and better awareness of EoE presenting symptoms across British Columbia.

Diagnostic Delay in Patients With Eosinophilic Esophagitis Has Not Changed Since the First Description 30 Years Ago: Diagnostic Delay in Eosinophilic Esophagitis

“…In these individuals, untreated EoE ultimately leads to strictures and food impactions, which often (in our experience) resemble the first contact to a gastroenterologist. Concomitant atopic conditions are known to be associated with the diagnosis of EoE in all age groups, including the very young children (25,26). Especially in children with a symptom complex of atopy and vomiting or failure to thrive, further diagnostic workup to rule out EoE should be considered (25).…”

“…Concomitant atopic conditions are known to be associated with the diagnosis of EoE in all age groups, including the very young children (25,26). Especially in children with a symptom complex of atopy and vomiting or failure to thrive, further diagnostic workup to rule out EoE should be considered (25). In our study population, 3 quarters (74%) had atopic features, confirming the association of atopy and EoE.…”