Eosinophilic Esophagitis - Experience of a Pediatric Allergology Unit

Background: Eosinophilic esophagitis (EE) is a chronic, immunologically mediated inflammatory disease characterized by eosinophilic infiltration of the esophageal epithelium. There is significant associated morbidity, with a negative impact in the quality of life.

Our objectives were the immunoallergological characterization and the scientific review of EE, in children.

Methods: Retrospective descriptive study of the patients with the diagnosis of EE followed in the pediatric allergy consultation of a tertiary hospital during a one-year period.

Results: Eleven patients were included, all with a history of atopy. The most frequent presenting symptoms were dysphagia, abdominal pain, vomiting and food impaction. All patients performed skin prick tests (SPTs), which were positive for house dust mites in 9 cases, and for food allergens in 7 cases. Specific IgE was positive for the allergens detected in SPTs. Atopy patch tests and Immuno Solid-phase Allergen Chip (ISAC) were performed in two patients, showing that one was sensitized to allergens not previously detected in SPTs.

The majority of patients are medicated with swallowed fluticasone. Those with food allergies are doing elimination diets for the identified allergens. During the follow-up period, all patients showed clinical improvement and three also revealed histological improvement.

Conclusion: We documented a greater predisposition for EE in males and a positive association with atopy. The presenting symptoms varied with age, with abdominal pain and vomiting being more frequent in young children, and dysphagia and food impaction in adolescents. The allergy assessment provided important clues to the etiology of the disease and helped in treatment management.