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The role of allergy evaluation in children with eosinophilic esophagitis
Abdulrahman Al-Hussaini1, Eman Al-Idressi, Mofareh Al-Zahrani
1Department of Pediatrics, Division of Gastroenterology, Children's Hospital, King Fahad Medical City, P. O. Box 59046, 11525, Riyadh, Saudi Arabia, aa_alhussaini@yahoo.com.
Insights
Allergy tests in Saudi children with eosinophilic esophagitis are common but have limited predictive value for dietary response. Swallowed fluticasone inhaler proved effective for managing this condition.
Area of Science:
- Pediatric Allergy and Immunology
- Gastroenterology
- Clinical Immunology
Background:
- Limited data exists on the utility of allergy testing for eosinophilic esophagitis management in Asia.
- Eosinophilic esophagitis (EoE) is an immune-mediated esophageal disease.
- Allergy evaluation plays a role in managing EoE, particularly in children.
Purpose of the Study:
- To determine the role and utility of allergy evaluation in the management of Saudi children diagnosed with eosinophilic esophagitis.
- To assess the effectiveness of allergy testing in guiding dietary interventions for EoE.
- To evaluate the response to both dietary and medical management in children with EoE.
Main Methods:
- Children diagnosed with EoE underwent allergy evaluation including total IgE, radio-allergosorbent assay, and skin prick tests.
- Dietary restrictions (elimination or elemental diets) were implemented based on allergy test results.
- Swallowed fluticasone inhaler was prescribed for patients unresponsive or non-adherent to dietary changes. Clinical, endoscopic, and histological assessments were performed.
Main Results:
- Food sensitization was observed in 14 out of 18 Saudi children with EoE, with common allergens including milk, soybean, wheat, egg, and nuts.
- Dietary elimination guided by allergy tests showed limited success, with only partial remission in 40% of older children.
- All patients (100%) responded positively to swallowed fluticasone inhaler, indicating its efficacy in EoE management.
Conclusions:
- Food sensitization is prevalent in Saudi children with eosinophilic esophagitis.
- Allergy testing demonstrated limited predictive value for response to dietary elimination in this pediatric population.
- Swallowed fluticasone inhaler is an effective treatment for eosinophilic esophagitis in children, regardless of allergy test results.
Background:
To our knowledge, in Asia, data on utility of allergy tests in management of eosinophilic esophagitis are lacking. The objective of our study was to determine the role of allergy evaluation in management of Saudi children with eosinophilic esophagitis.
Methods:
Children diagnosed as having eosinophilic esophagitis during the period from 2009 to 2012 were referred to an allergist for allergy evaluation. The allergy evaluation consisted of total IgE level, radio-allergosorbent assay, and skin prick test. Depending on the results of the allergy tests, a restricted or elemental diet was established. Swallowed fluticasone inhaler was prescribed to patients who rejected or failed to respond to the diet. Clinical, endoscopic, and histological evaluation was performed in 8 weeks to assess response.
Results:
Eighteen children with eosinophilic esophagitis were included (13 males; mean age 5 years, range 1-11). Sensitization to foods was demonstrated in 14 patients: 4 with a positive test for a single food (28.5%), 1 for 2 food allergens (7%), and 9 for ≥3 food allergens (64.5%). The most common food allergens were milk, soybean, wheat, egg, and nuts. Three young children out of the total 14 patients responded to elemental formula. Four of the 10 older children on the allergy testing guided-dietary restriction achieved partial remission and the remaining 6 did not respond. All 10 patients responded to a swallowed fluticasone inhaler.
Conclusion:
Although food sensitizations in Saudi children with eosinophilic esophagitis are common, the allergy tests had limited predictive value for the response to dietary elimination.
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