High Incidence of Atopy in Young Children with Eosinophilic Esophagitis

Abstract

Eosinophilic esophagitis (EoE) has been strongly associated with atopy in children and adults. However, there is a paucity of data regarding young children with this disease. We retrospectively studied 28 children diagnosed with EoE < 6 years of age who met criteria and were identified via ICD-9 code 530.13 in the electronic medical record. The average age at diagnosis was 2.8 years + 1.6 years. There were 21 males and 7 females: 43% had eczema, 39% had asthma, and 29% had allergic rhinitis. The most common presenting symptoms were vomiting (64%) and failure to thrive (43%). Milk allergy had been diagnosed in 39% of patients. Histopathology revealed a mean eosinophil count of 42 eosinophils/hpf in the mid esophagus and 63 eosinophils/hpf distally. Positive prick skin tests to at least one environmental antigen were seen in 39% of children and 64% had a positive prick skin test to at least one food allergen. The most common food allergens were egg white(75%) and soy(61%). Most common environmental allergens were tree pollen (32%), grass pollen (25%), and dust mite(25%). As reported in older children and adults, there is a high incidence of atopic disorders including eczema, asthma, food allergies, and allergic rhinitis in young children with EoE. The presence of atopy, along with vomiting or failure to thrive in young children, may be suggestive of EoE, and should prompt consideration for earlier diagnostic interventions. Additional studies of this population are needed to clarify the specific nature of the association between atopy and EoE.