Is There a Seasonal Variation in the Incidence and Severity of Allergic Eosinophilic Esophagitis?

Abstract

Introduction: Allergic eosinophilic esophagitis (AEE) is thought to be an allergic reaction characterized by dense eosinophilic inflammation (>15 eosinophils per high power field) of the esophageal epithelium. We examined the seasonal distribution of newly diagnosed AEE patients in order to establish variations with seasons associated with increased atopy. Methods: Retrospective analysis of all newly-diagnosed children with AEE over a five-year period (December 1998 to November 2003) at our institution. Results: A total of 194 children (mean age 8.2 years, median age 8.0 years, age range 0.42 - 20 years) were diagnosed with AEE during the study period. A higher number of patients were newly-diagnosed, and had denser esophageal mucosal eosinophil counts in the spring/fall seasons combined, compared to the summer/winter seasons combined (p= 0.031 and 0.016 respectively). On comparing the seasons individually, significantly fewer patients were newly-diagnosed during winter compared to either spring or fall, but similar to summer. The severity of inflammation was higher in fall compared to winter or summer, but similar to that in spring. Conclusions: The higher number of newly-diagnosed patients and the increased esophageal eosinophilic inflammation during seasons of increased aeroallergen concentrations and atopy (i.e spring/fall), further support an allergic basis to AEE and suggest a role for aeroallergens in the pathogenesis of AEE. Consideration should be given to testing AEE patients for aeroallergens.