Aeroallergen sensitisation as a risk factor for paediatric eosinophilic esophagitis

Background: Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease frequently associated with atopic conditions in children. However, the extent and nature of this association remain unclear. We retrospectively estimated the prevalence of atopic conditions in a paediatric population with EoE and we prospectively screened children with aeroallergen sensitisation to estimate the prevalence of EoE. Methods: We retrospectively described atopic profiles of paediatric patients previously diagnosed with EoE. We prospectively recruited children with confirmed aeroallergen sensitisation, who completed a screening questionnaire targeting symptoms suggestive of EoE. Patients with positive screening results were referred to a paediatric gastroenterologist for further evaluation, including esophagogastroduodenoscopy with biopsy when indicated, to confirm or exclude EoE. Results: In the retrospective cohort of 83 patients (median age: 9.4 years), 69.9% were sensitised to aeroallergens, 61.4% had asthma, 57.8% had allergic rhinitis (AR), 41.0% had atopic dermatitis and 43.4% had IgE-mediated food allergies. Neither the severity of these conditions nor the number of concurrent atopic diseases correlated with peak eosinophil counts on esophageal biopsies. In the prospective cohort, 168 aeroallergen-sensitised children (median age: 9.6 years) were enrolled. Of these, 56 (33.3%) had positive screening questionnaires and 3 were subsequently diagnosed with EoE. Notably, AR—regardless of its severity—was associated with an increased risk of EoE-related symptoms. Conclusion: A high prevalence of aeroallergen sensitisation was observed among children with EoE. We recommend routine screening of patients with respiratory sensitisation—especially those with AR—using a brief questionnaire, followed by a paediatric gastroenterologist consultation for EoE evaluation.