Seasonal Distribution and Eosinophilic Esophagitis

Elitsur, Yoram; Aswani, Rohit; Lund, V. H.; Dementieva, Yulia

doi:10.1097/mcg.0b013e31826df861

Cited by 31 publications

(8 citation statements)

References 10 publications

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“…103 While this may be counterintuitive (some allergic diseases such as asthma and atopic dermatitis are felt to be more common in urban areas), there are other studies on EoE that support this as well. 65,104 This raises the question of whether vegetation or environmental exposures more likely to be found in rural areas are risk factors for EoE, but additional research is required to explore these possibilities.…”

Section: Increasing Incidence and Risk Factorsmentioning

confidence: 99%

Epidemiology of Eosinophilic Esophagitis

Dellon¹

2014

Gastroenterology Clinics of North America

269

222

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Great strides have been made in understanding the epidemiology of EoE over the past two decades. Initial research focused on case description and characterization of the burden of disease. Research is now shifting to risk factor ascertainment, resulting in new and intriguing etiologic hypotheses. This paper will review the current knowledge related to the epidemiology of EoE. Demographic features and natural history will be described, data summarizing the prevalence and incidence of EoE throughout the world will be highlighted, and risk factors for EoE will be discussed. EoE can occur at any age, there is a male predominance, it is more common in Whites, and there is a strong association with atopic diseases. EoE is chronic, relapses are frequent, and persistent inflammation increases the risk of fibrostenotic complications. The prevalence is currently estimated at 0.5–1 in 1000, and EoE is now the most common cause of food impaction. EoE can be seen in 2–7% of patients undergoing endoscopy for any reason, and 12–23% undergoing endoscopy for dysphagia. The incidence of EoE is approximately 1/10,000 new cases per year, and the rise in incidence is outpacing increases in recognition and endoscopy volume. The reasons for this evolving epidemiology are not yet fully delineated, but possibilities include changes in food allergens, increasing aeroallergens and other environmental factors, the decrease of H. pyloriand early life exposures.

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Section: Increasing Incidence and Risk Factorsmentioning

confidence: 99%

Epidemiology of Eosinophilic Esophagitis

Dellon¹

2014

Gastroenterology Clinics of North America

269

222

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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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“…It is unclear whether there are differences in disease presentation and response to management in rural or other nonurban populations. 16,18–20 As such, characterization of different patient populations is important to obtain a clearer understanding of the disease process and to optimize management strategies. In 2015, 42% of Arkansas’ population lived in nonurban areas vs 15% for the US population as a whole.…”

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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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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Seasonal Distribution and Eosinophilic Esophagitis

Cited by 31 publications

References 10 publications

Epidemiology of Eosinophilic Esophagitis

Epidemiology of Eosinophilic Esophagitis

An allergist's perspective to the evaluation of Eosinophilic Esophagitis

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

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