title: Seasonal exacerbation of esophageal eosinophilia in children with eosinophilic esophagitis and allergic rhinitis.
abstract: BACKGROUND
  Evidence supports a possible link between eosinophilic esophagitis (EoE) and environmental aeroallergens, which can manifest as seasonal exacerbation of esophageal eosinophilia. Few studies have examined this link in pediatric patients with EoE.
  
  
  OBJECTIVE
  To identify the proportion of patients with seasonal induced esophageal eosinophilia.
  
  
  METHODS
  A retrospective chart review was conducted of all patients diagnosed with EoE at the authors' institution. Demographic data were collected by chart review. Seasonal variation or flare was defined as a change from fewer than to at least 15 eosinophils per high-power field and a minimum of a 2-fold increase in eosinophil count between 2 consecutive biopsy specimens in different seasons without dietary or medication modifications.
  
  
  RESULTS
  Of the 1,180 patients with EoE, 160 (14%) were suspected of having aeroallergen-associated triggers by history. Of these 160 patients, 32 (20%) had biopsy examination-confirmed variation of EoE triggered by aeroallergens. Most of these patients were boys (84%), all had a history or examination consistent with allergic rhinitis, and most had a history of asthma (75%). Thirty-two subjects had obvious seasonal variation, 22 of whom also had known food-induced symptoms.
  
  
  CONCLUSIONS
  Children with EoE and allergic rhinitis might have exacerbations in their esophageal eosinophilia during certain seasons depending on the specific aeroallergens to which they are sensitized. Identification of environmental allergens to sensitized patients is important and can guide therapy.
authors.affiliation: Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Gita
authors.initials: G
authors.lastname: Ram
authors.affiliation: Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Juhee
authors.initials: J
authors.lastname: Lee
authors.affiliation: Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Megan
authors.initials: M
authors.lastname: Ott
authors.affiliation: Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Terri F
authors.initials: TF
authors.lastname: Brown-Whitehorn
authors.affiliation: Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cianferoni
authors.affiliation: Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Michele
authors.initials: M
authors.lastname: Shuker
authors.affiliation: Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; GlaxoSmithKline, Philadelphia, Pennsylvania.
authors.forename: Mei-Lun
authors.initials: ML
authors.lastname: Wang
authors.affiliation: Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Ritu
authors.initials: R
authors.lastname: Verma
authors.affiliation: Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Liacouras
authors.affiliation: Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: spergel@email.chop.edu.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Spergel
mesh_terms: D000485:Allergens / Q000276:immunology; D001249:Asthma / Q000276:immunology; D002648:Child; D018450:Disease Progression; D004802:Eosinophilia / Q000276:immunology*; D057765:Eosinophilic Esophagitis / Q000276:immunology*; D004804:Eosinophils / Q000166:cytology / Q000276:immunology; D004947:Esophagus / Q000276:immunology; D005260:Female; D006801:Humans; D019570:Inhalation Exposure; D008297:Male; D012189:Retrospective Studies; D065631:Rhinitis, Allergic / Q000276:immunology*; D012621:Seasons
chemical_list: D000485:Allergens