Increased prevalence of airway reactivity in children with eosinophilic esophagitis.
BACKGROUND
Asthma is prevalent in children with eosinophilic esophagitis (EoE) estimated at 24-42% in prior studies versus 9% for the general population. However, pulmonary function and airway hyperresponsiveness (AHR) in children with EoE have not been previously defined.


METHODS
A cross-sectional prospective study was conducted of children ages 7-18 years with EoE and healthy controls. Methacholine bronchial challenge and exhaled nitric oxide were assessed. As measures of atopy and immune activation, peripheral blood was analyzed for total IgE, specific IgE to selected aeroallergens, eosinophil count, and serum cytokines including eotaxin.


RESULTS
EoE subjects (n = 33) and healthy controls (n = 37) demonstrated similar, normal baseline spirometry. AHR occurred in 33% of children with EoE and 11% of healthy controls (P = 0.04; 95% confidence intervals [19%, 52%] and [4%, 26%], respectively). The majority of EoE subjects with AHR had no prior diagnosis of asthma. Overall, 69.7% of EoE subjects had either asthma or AHR. For EoE subjects, total serum IgE was the only biomarker associated with a greater risk of AHR (OR = 9.643, 95%CI 1.633, 56.925). EoE subjects with and without asthma were similar to healthy controls in mean levels of serum cytokines (IL-5, IL-9, EGF, FGF-2, eotaxin). In exploratory analyses, the subgroup with EoE and asthma without asthma controller therapy had higher mean FGF-2 than EoE subjects without asthma (110 pg/ml vs. 65 pg/ml, P = 0.0426).


CONCLUSIONS
Asthma and AHR may be more prevalent than previous estimates in children with EoE. For subjects with EoE, elevation in serum IgE was associated with a greater risk of AHR.
Section of Pulmonology, Allergy and Sleep Medicine, Indiana University, Indiana.
Nadia L
NL
Krupp
Wells Center for Pediatric Research, Indiana University, Indiana.
Sarita
S
Sehra
Department of Biostatistics, Indiana University, Indiana.
James E
JE
Slaven
Wells Center for Pediatric Research, Indiana University, Indiana.
Mark H
MH
Kaplan
Section of Pediatric Gastroenterology, Indiana University, Indiana.
Sandeep
S
Gupta
Wells Center for Pediatric Research, Indiana University, Indiana.
Robert S
RS
Tepper
D000293:Adolescent; D001944:Breath Tests; D001985:Bronchial Provocation Tests; D002648:Child; D003430:Cross-Sectional Studies; D057765:Eosinophilic Esophagitis / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008168:Lung / Q000503:physiopathology; D008297:Male; D009569:Nitric Oxide / Q000032:analysis; D015995:Prevalence; D011446:Prospective Studies; D012130:Respiratory Hypersensitivity / Q000453:epidemiology* / Q000503:physiopathology
D009569:Nitric Oxide
allergy; asthma and early wheeze; biomarkers; nitric oxide (NO); pulmonary function testing