title: IgE-associated food allergy alters the presentation of paediatric eosinophilic esophagitis.
abstract: Links between food allergens and eosinophilic esophagitis (EoE) have been established, but the interplay between EoE- and IgE-associated immediate hypersensitivity to foods remains unclear.
  
  
  
  We sought to determine the prevalence of IgE-associated food allergy at the time of diagnosis of EoE in children and to determine whether differences existed in presentation and disease compared to subjects with EoE alone.
  
  
  
  Eosinophilic esophagitis patients were stratified based on the diagnosis of IgE-associated immediate hypersensitivity (EoE + IH vs. EoE-IH). Clinical, histologic, pathologic, and endoscopic differences were investigated using a retrospective database.
  
  
  
  We found that 29% of the 198 EoE patients in our cohort had EoE + IH. These subjects presented at a younger age than those without IH (6.05 vs. 8.09 years, P = 0.013) and were more likely to have comorbid allergic disease. Surprisingly, the EoE + IH group presented with significantly different clinical symptoms, with increased dysphagia, gagging, cough, and poor appetite compared to their counterparts in the EoE-IH group. Male gender, allergic rhinitis, the presence of dysphagia, and younger age were independently associated with having EoE + IH. Specific IgE levels to common EoE-associated foods were higher in EoE + IH, regardless of eliciting immediate hypersensitivity symptoms. In contrast, IgE levels for specific foods triggering EoE were relatively lower in both the groups than IgE levels for immediate reactions.
  
  
  
  Immediate hypersensitivity is common in children with EoE and identifies a population of EoE patients with distinct clinical characteristics. Our study describes a subtype of EoE in which IgE-mediated food allergy may impact the presentation of paediatric EoE.
authors.affiliation: Division of Allergy & Immunology, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Northwestern University Food Allergy Research Consortium, Chicago, IL, USA.
authors.forename: B J
authors.initials: BJ
authors.lastname: Pelz
authors.affiliation: Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Wechsler
authors.affiliation: Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: K
authors.initials: K
authors.lastname: Amsden
authors.affiliation: Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: K
authors.initials: K
authors.lastname: Johnson
authors.affiliation: Division of Allergy & Immunology, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Northwestern University Food Allergy Research Consortium, Chicago, IL, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Singh
authors.affiliation: Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: B K
authors.initials: BK
authors.lastname: Wershil
authors.affiliation: Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.|Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: A F
authors.initials: AF
authors.lastname: Kagalwalla
authors.affiliation: Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. p-bryce@northwestern.edu.|Northwestern University Food Allergy Research Consortium, Chicago, IL, USA. p-bryce@northwestern.edu.
authors.forename: P J
authors.initials: PJ
authors.lastname: Bryce
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D057765:Eosinophilic Esophagitis / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D005502:Food / Q000009:adverse effects; D005512:Food Hypersensitivity / Q000150:complications* / Q000453:epidemiology / Q000276:immunology*; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000150:complications* / Q000453:epidemiology / Q000276:immunology*; D007223:Infant; D008297:Male; D010641:Phenotype; D015995:Prevalence; D012189:Retrospective Studies; D063189:Symptom Assessment
keywords: IgE; eosinophilic esophagitis; food allergy; food sensitization