title: Pediatric eosinophilic esophagitis: the Vanderbilt experience.
abstract: BACKGROUND
  Eosinophilic esophagitis (EoE) is a chronic allergic disease of the esophagus unresponsive to treatment with proton pump inhibitors. A combination of immediate, IgE-mediated and delayed, and non-IgE-mediated immune reactions to foods and aeroallergens is thought to contribute to disease pathogenesis. Optimal methods to assess for food allergen sensitization have been debated. Patients with EoE often have comorbid atopic diseases.
  
  
  OBJECTIVE
  To characterize pediatric patients diagnosed with EoE at a single institution within the southeastern United States.
  
  
  METHODS
  A retrospective study was conducted to evaluate 211 pediatric patients with EoE at Vanderbilt University Medical Center. Aeroallergen and food sensitization profiles obtained by skin prick testing (SPT), atopy patch testing (APT), and history of associated atopic diseases were analyzed.
  
  
  RESULTS
  Older patients with EoE showed greater aeroallergen sensitization; the most common allergens were pollens and dust mite. Younger patients showed greater sensitization to foods by SPT and APT. The most common foods identified by SPT were peanut, egg, and soy. The most common foods identified by APT were potato, pork, and wheat. Comorbid atopic disease was common. Patients with atopic dermatitis did not show significantly greater sensitization to foods by SPT or APT compared with patients without atopic dermatitis.
  
  
  CONCLUSIONS
  In pediatric patients with EoE, sensitization to aeroallergens increases with age, whereas sensitization to foods decreases with age. Concomitant atopic disease is common. APT is useful to identify additional food allergens not detected by SPT. A history of atopic dermatitis does not appear to be associated with nonspecific positivity by SPT or APT.
authors.affiliation: Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: nicolechadha@yahoo.com.
authors.forename: S Nicole
authors.initials: SN
authors.lastname: Chadha
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Li
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Hernan
authors.initials: H
authors.lastname: Correa
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Dedrick
authors.initials: D
authors.lastname: Moulton
authors.affiliation: Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Donna S
authors.initials: DS
authors.lastname: Hummell
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000453:epidemiology*; D057765:Eosinophilic Esophagitis / Q000175:diagnosis / Q000453:epidemiology*; D004947:Esophagus / Q000473:pathology; D005260:Female; D005512:Food Hypersensitivity / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D010328:Patch Tests; D012189:Retrospective Studies; D055815:Young Adult