Specific IgG4 to milk proteins during oral immunotherapy for milk allergy: relationship to eosinophilic esophagitis

Abstract

RATIONALE: Eosinophilic esophagitis (EoE) is an increasing, allergic disease with variable symptoms that progress with age. While adult predominant studies have shown symptoms differ significantly in male and female patients, no pediatric studies have been performed. We compared clinical features by sex in a pediatric EoE cohort. METHODS: At endoscopy, 98 EoE patients were recruited for a cross sectional study. Participants completed demographic and clinical questionnaires and medical records were reviewed for esophageal biopsy results. RESULTS: In the whole cohort, ages ranged from 2 to 19 (median 12) and 89% were white. There were 39 female and 59 male patients, and there were no significant sex-related differences in race, body mass index (BMI), concurrent allergic diseases, peak esophageal eosinophil counts, or symptoms. For further analysis, patients were divided into four groups based on sex and age: i) males<13, ii) males> _13, iii) females<13, and iv) females> _13. Prevalence of reported food allergies was higher in male patients<13 (65%, p50.005). Peak eosinophil counts were higher in males> _13 compared with females> _13 [median 63 eosinophils/high power field (eos/hpf) and 44 eos/hpf respectively, p50.045]. Females> _13 were more likely to have abdominal pain (68%, p50.01), and males> _13 were more likely to report food impactions (78%, p50.005). BMI was lowest in females<13 and highest in females>13 (p<0.001). Histologic remission was significantly less frequent in males<13 (31%) compared with females<13 (69%) (p50.043). CONCLUSIONS: There were age-related sex differences in symptoms, markers of allergy, and outcomes in pediatric EoE patients. These group differences appear to result from separate changes in both sexes after adolescence.