Patients With Asthma, Other Allergic Diseases May Have Higher Prevalence of EoE

Patients with allergic disease may be more likely than the general population to have eosinophilic esophagitis (EoE), researchers have found.

In their study of adults with allergic rhinitis, asthma, atopic dermatitis, or IgE-mediated food allergy, the group found that the patients were likely to report solid food dysphagia, food impaction and other stomach issues—common symptoms of EoE. While the prevalence of EoE is estimated to be 0.5% in the general population, the researchers found that among their patients with allergic disease, the prevalence was as high as 16.5%.

“We estimate that a large proportion of patients with allergic disease and dysphagia may have EoE and believe that our findings should serve as a foundation for future prospective studies to confirm our hypothesis,” wrote the researchers. “Based on our findings, we recommend that physicians who care for patients with allergic conditions ask about solid food dysphagia and food impactions as part of routine care.We anticipate that inquiring about EoE-specific symptoms in high-risk populations coulddramatically decrease the delay in EoE diagnosis and will lead to improved patient outcomes.”

Throughout 2021, the researchers surveyed 100 patients visiting their practice, 11% of which reported that they experienced esophageal food impaction in the last year; 8% of these patients said this happened on more than 1 occurrence. One patient reported 10 food impactions and another reported 25 food impactions over the last year.

Survey findings also revealed that 40% of patients reported abdominal pain, 22% reported nausea, 43% reported reflux, and 39% reported difficulty swallowing solid foods at least once in the last week.

“Perhaps the most alarming was the high prevalence of patients who reported one or more food impactions in the previous year. Solid food impactions are a known complication of untreated EoE due to changes in the esophageal mucosa, suggesting that many of these patients have had ongoing inflammation for years,” explained the researchers. “This complication can be prevented if EoE is diagnosed early in the course of disease and the patient begins therapy. As allergists may be seeing these patients for the management of their other allergic co-morbidities, patients should be routinely asked about symptoms of esophageal dysfunction and referred for further work-up ofEoE if warranted.”

There were 44 patients who were characterized as having typical EoE symptoms; 5 received a Cytosponge procedure, revealing that 1 was positive for esophageal eosinophilia and resulting in an EoE prevalence of 8.8%. Two more patients were diagnosed with EoE after undergoing an endoscopy, and another patient who received a negative Cytosponge result but later underwent an endoscopy was diagnosed with esophageal eosinophilia and duodenal erosions, bringing the prevalence up to 16.5%. Of the 37 patients with atypical EoE symptoms, 5 received the Cytosponge procedure, showing none had esophageal eosinophilia.

The researchers noted their small sample size, underscoring the limited ability to estimate the true prevalence of EoE among these patients.

Reference

Eid R, Noonan E, Borish L, et al. High prevalence of gastrointestinal symptoms and undiagnosed eosinophilic esophagitis among allergic adults. J Allergy Clin Immunol Pract. Published online September 29, 2022. doi:10.1016/j.jaip.2022.09.028.