The role of allergy evaluation in children with eosinophilic esophagitis.
BACKGROUND
To our knowledge, in Asia, data on utility of allergy tests in management of eosinophilic esophagitis are lacking. The objective of our study was to determine the role of allergy evaluation in management of Saudi children with eosinophilic esophagitis.


METHODS
Children diagnosed as having eosinophilic esophagitis during the period from 2009 to 2012 were referred to an allergist for allergy evaluation. The allergy evaluation consisted of total IgE level, radio-allergosorbent assay, and skin prick test. Depending on the results of the allergy tests, a restricted or elemental diet was established. Swallowed fluticasone inhaler was prescribed to patients who rejected or failed to respond to the diet. Clinical, endoscopic, and histological evaluation was performed in 8 weeks to assess response.


RESULTS
Eighteen children with eosinophilic esophagitis were included (13 males; mean age 5 years, range 1-11). Sensitization to foods was demonstrated in 14 patients: 4 with a positive test for a single food (28.5%), 1 for 2 food allergens (7%), and 9 for ≥3 food allergens (64.5%). The most common food allergens were milk, soybean, wheat, egg, and nuts. Three young children out of the total 14 patients responded to elemental formula. Four of the 10 older children on the allergy testing guided-dietary restriction achieved partial remission and the remaining 6 did not respond. All 10 patients responded to a swallowed fluticasone inhaler.


CONCLUSIONS
Although food sensitizations in Saudi children with eosinophilic esophagitis are common, the allergy tests had limited predictive value for the response to dietary elimination.
Department of Pediatrics, Division of Gastroenterology, Children's Hospital, King Fahad Medical City, P. O. Box 59046, 11525, Riyadh, Saudi Arabia, aa_alhussaini@yahoo.com.
Abdulrahman
A
Al-Hussaini
Eman
E
Al-Idressi
Mofareh
M
Al-Zahrani
D000730:Androstadienes / Q000627:therapeutic use; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D057765:Eosinophilic Esophagitis / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000628:therapy; D005260:Female; D000068298:Fluticasone; D005500:Follow-Up Studies; D005512:Food Hypersensitivity / Q000150:complications / Q000175:diagnosis; D005526:Food, Formulated; D006801:Humans; D006967:Hypersensitivity / Q000150:complications* / Q000175:diagnosis; D007073:Immunoglobulin E / Q000097:blood; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D011852:Radioallergosorbent Test / Q000379:methods; D012189:Retrospective Studies; D012882:Skin Tests / Q000379:methods
D000730:Androstadienes; D018926:Anti-Allergic Agents; D007073:Immunoglobulin E; D000068298:Fluticasone