Relationship of pediatric eosinophilic esophagitis diagnosis to pollen and mold counts

Schlegel, C; Quintanilla, Norma; Olivé, Anthony; Minard, Charles G.; Davis, Carla M.

doi:10.1016/j.anai.2014.06.007

Cited by 12 publications

(8 citation statements)

References 9 publications

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“…Several studies performed in pediatric populations have failed to demonstrate an effect of aeroallergens on EoE diagnosis or clinical symptoms. 15–17 …”

Section: Discussionmentioning

confidence: 99%

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Effects of allergen sensitization on response to therapy in children with eosinophilic esophagitis

Pesek

Rettiganti

O’Brien

et al. 2017

Annals of Allergy, Asthma & Immunology

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Background: In children with eosinophilic esophagitis (EoE) foods are the most common disease triggers, but environmental allergens are also suspected culprits. Objective: To determine the effects of environmental allergen sensitization on response to treatment in children with EoE in the southeastern United States. Methods: Patients 2 to 18 years old who were referred to the Arkansas Children’s Hospital Eosinophilic Gastrointestinal Disorders Clinic from January 2012 to January 2016 were enrolled in a prospective, longitudinal cohort study with collection of demographics, clinical symptoms, medical history, allergy sensitization profiles, and response to treatment over time. Comparisons were made between complete responders (peak esophageal eosinophil count <15 per high-power field [HPF]) and nonresponders (>25 eosinophils per HPF) after treatment with diet elimination alone, swallowed corticosteroids alone, or diet elimination and swallowed corticosteroids. Sensitization patterns to environmental allergens found in the southeastern United States were analyzed for the effect on treatment response. Results: A total of 223 individuals were enrolled. Of these, 182 had environmental allergy profiling and at least one endoscopy while receiving proton pump inhibitor (PPI) therapy. Twenty-nine individuals had PPI-responsive EoE and were excluded from further analysis, leaving 123 individuals with none-PPI-responsive EoE who were further analyzed; 72 (58.5%) were complete responders and 33 (26.8%) were nonresponders. Seventeen individuals (13.8%) were partial responders (≥ 1 but ≤ 25 eosinophils per HPF) and excluded from further analysis. Nonresponders were more likely to be sensitized to perennial allergens (P = .02). There was no significant difference in response based on seasonal allergen sensitization. Individuals with mold or cockroach sensitization were more likely to fail combination diet and swallowed corticosteroid treatment (P = .02 and P = .002). Conclusion: Perennial allergen and mold sensitization may lead to nonresponse to EoE treatment in some patients. Additional studies are needed to further understand the effect of environmental allergens on EoE. Trial Registration: http://ClinicalTrials.gov identifier: NCT01779154.

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“…Several studies performed in pediatric populations have failed to demonstrate an effect of aeroallergens on EoE diagnosis or clinical symptoms. 15–17 …”

Section: Discussionmentioning

confidence: 99%

“…11–14 However, other studies have found no clear link among aeroallergen sensitization, symptom onset, and seasonal diagnosis of EoE. 15–18 …”

Section: Introductionmentioning

confidence: 99%

Effects of allergen sensitization on response to therapy in children with eosinophilic esophagitis

Pesek

Rettiganti

O’Brien

et al. 2017

Annals of Allergy, Asthma & Immunology

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“…73 Overall, there are five reports of seasonality of diagnosis correlating with pollen season and one report that did not find any seasonality. 68-71,74,75 …”

Section: The Role Of Aeroallergens In Eoementioning

confidence: 99%

An allergist's perspective to the evaluation of Eosinophilic Esophagitis

Spergel

2015

Best Practice & Research Clinical Gastroenterology

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Eosinophilic Esophagitis (EoE) is a classic atopic disease as it shares features with other atopic disease on all levels including pathogenesis, genetics, epidemiology, and treatment options. EoE has elements of Th2 pathogenesis with increase levels of Th2 cytokines (IL4, 5, and 13). In addition, it shares atopic genetic risk factors including thymic stromal lymphopoietin (TSLP) loci as a risk factor in genome wide association studies. EoE patients have a higher rate of other atopic disease (asthma, allergic rhinitis and food allergy) compared to the general population indicating their atopic phenotype. Like asthma, atopic dermatitis or food allergy, EoE has increased in the last 20 years. Treatment options include the basic principle of other atopic diseases include using topical steroids or avoidance of the triggers (food or pollen). An allergist provides a critical role as they are experts in the treatment of atopic disease including avoidance strategies.

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“…51 While, another report did not confirm this relationship, 52 a retrospective cohort study of 127 adults found that the rate of EoE diagnosis throughout the year was correlated with fluctuations in daily average pollen counts in the Washington, DC, area. 47 Specifically, there were approximately twice as many cases of EoE in the spring than the winter and that there was a strong statistical correlation between case volume and grass pollen.…”

Section: Resultsmentioning

confidence: 98%

“…8,37,38,41,42,45,47-49,51,52 However, these studies are still at a general level, and it remains to be seen whether trends in seasonality or climate will be able to be linked to a discrete environmental factor that could impact an individual patient. A similar statement could be made for EoE being more common in areas with low population density.…”

Section: Discussionmentioning

confidence: 99%

The Role of Environmental Exposures in the Etiology of Eosinophilic Esophagitis

Green

Cotton

Dellon

2015

Mayo Clinic Proceedings

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Eosinophilic esophagitis (EoE) is an emerging clinicopathologic entity defined by abnormal esophageal eosinophilic infiltration. Management of this disease is hampered by limited understanding of etiologic and controllable risk factors. The aim of this systematic review was to determine the environmental risk factors for EoE. We searched PubMed, Web of Science, and EMBASE databases from 1950 through June 30, 2015. To identify additional relevant studies, we hand searched bibliographies of included articles. We limited the review to articles using human subjects, and consisting of case reports, case series, cross-sectional and cohort studies, or clinical trials. 19 articles discuss the risk of environmental exposures on EoE and indicate that environment plays a large role in the etiology of EoE. Seasonal, geographic, and climate-based differences in disease prevalence have been shown but the exact mediators of this process, possibly aeroallergens that vary over time and from place to place, remains elusive.

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Relationship of pediatric eosinophilic esophagitis diagnosis to pollen and mold counts

Cited by 12 publications

References 9 publications

Effects of allergen sensitization on response to therapy in children with eosinophilic esophagitis

Effects of allergen sensitization on response to therapy in children with eosinophilic esophagitis

An allergist's perspective to the evaluation of Eosinophilic Esophagitis

The Role of Environmental Exposures in the Etiology of Eosinophilic Esophagitis

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