Eosinophilic oesophagitis a late manifestation of atopic march in children

Roshini Claire Anthony
23 Mar 2018

Eosinophilic oesophagitis appears to be a late manifestation of the atopic march, according to a study presented at the recent 2018 AAAAI/WAO* congress held in Orlando, Florida, US.

“The atopic march describes the natural development of atopic dermatitis, IgE-mediated food allergy, asthma, and allergic rhinitis,” said the researchers.

“Our findings indicate that eosinophilic oesophagitis falls into the pattern of atopic march, although eosinophilic oesophagitis tends to be diagnosed later in the progression,” said study author Professor Jonathan Spergel from the Children’s Hospital of Philadelphia, Pennsylvania, US.

In this case-control study, data of 130,457 children (aged <1 year at database entry) were evaluated to identify a potential link between atopic dermatitis, IgE-mediated food allergy, asthma, or allergic rhinitis and the risk of developing eosinophilic oesophagitis.

Over a follow-up period of ≥24 months, 139 children developed eosinophilic oesophagitis, with a prevalence of 0.11 percent. Male and Caucasian children appeared to be at an elevated risk of developing eosinophilic oesophagitis compared with other groups (odds ratio, 2.7 and 2.4, respectively).

The peak age for a diagnosis of eosinophilic oesophagitis was 2.7 years which was lower than that of allergic rhinitis (4.1 years) but higher than that of atopic dermatitis (0.4 years), IgE-mediated food allergy (1 year), and asthma (1.1 years).

Atopic dermatitis (hazard ratio [HR], 2.7, 95 percent confidence interval [CI], 1.9–4.0), IgE-mediated food allergy (HR, 8.9, 95 percent CI, 6.3–12.4), and asthma (HR, 2.2, 95 percent CI, 1.6–3.1) were independently associated with an elevated risk for eosinophilic oesophagitis. [AAAAI/WAO 2018, abstract 274]

In contrast, eosinophilic oesophagitis was significantly associated with an elevated risk of developing subsequent allergic rhinitis (HR, 3.8, 95 percent CI, 1.4–2.7).

The cumulative effect of the various atopic conditions on the risk of eosinophilic oesophagitis increased with the number of conditions (HR, 3.9, 95 percent CI, 2.6–5.7; HR, 6.5, 95 percent CI, 4.3–9.9; HR, 9.8, 95 percent CI, 5.8–16.8; and HR, 12.2, 95 percent CI, 5.0–30.0 for one, two, three, and four conditions, respectively; p≤0.001 for all associations).

“[Atopic dermatitis, IgE-mediated food allergy, and asthma] independently and cumulatively increase the risk of subsequent eosinophilic oesophagitis, while eosinophilic oesophagitis increases the risk of subsequent allergic rhinitis,” said the researchers.

“If a child was diagnosed with all three conditions, they are even more likely to develop eosinophilic oesophagitis than if they only had one or two other conditions,” said Spergel.


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