ATOPY PATCH TESTING IN PEDIATRIC PATIENTS WITH PROTON PUMP NON-RESPONSIVE EOSINOPHILIC ESOPHAGITIS

Abstract

Introduction The role of atopy patch testing (APT) in Eosinophilic Esophagitis (EoE) remains controversial with no clear guidance for utility in the Food Allergy Practice Parameters. This exploratory study examines the use of APT in pediatric patients with EoE. Methods A retrospective chart review from 08/2017 to 06/2018 was conducted at a large academic Allergy/Immunology Division. Pediatric patients with a diagnosis of EoE who underwent APT in conjunction with skin prick testing to guide food elimination were identified. Results of APT and response to dietary elimination were evaluated using descriptive statistics. Results 45 patients, ages 2 to 18 years, were identified with initial screening. 5 patients had APT prior to second biopsy showing PPI responsiveness and were excluded. Three patients were lost to follow-up. 1 patient was diagnosed with an eating disorder and did not undergo food elimination. 5 additional patients have follow-up endoscopy pending. A total of 31 patients were included in final assessment: 23 males and 8 females, average age 9 years. Of the 31 patients, 1 had improvement on biopsy that could be uniquely attributed to APT. The remaining 30 patients (97%) had APT that was not useful in identification of triggering foods. Conclusions In our sample of pediatric EoE patients, APT was not useful in identifying foods for removal. Given the productivity loss for both patients and parents as well as the increased financial costs of patch tests and three additional visits, guidelines on EoE management should be adapted to more strongly discourage APT for identification of triggering foods.