Eosinophilic esophagitis incidence during single and multiple food oral immunotherapy

In the past decade, significant progress has occurred with using oral immunotherapy (OIT) in the treatment of IgE-mediated food allergies. Eosinophilic esophagitis (EoE) is a known potential adverse effect of OIT.

Primary objective: to assess the rate of a new diagnosis of EoE.

to evaluate the development of EoE among patients undergoing single versus multiple food OIT, to assess the symptoms among those who developed EoE, and to identify which foods were associated with the development of EoE.

A retrospective review of patients undergoing OIT from 2018 to May 2024 at the Children's Hospital of Philadelphia was performed.

This study identified 1200 children who have undergone or were undergoing OIT. A total of 51 patients underwent evaluation for suspected EoE, and 8 were ultimately diagnosed with EoE. No difference in EoE development was observed between those on single versus multi-food OIT. Peanut and egg were the most common foods for which patients experienced gastrointestinal symptoms. No patients on milk, wheat, or soy OIT were found to have EoE.

In a cohort of 1200 children on OIT at a tertiary pediatric hospital with robust OIT and EoE programs, the rate of newly diagnosed EoE during OIT was found to be 0.7%, which is lower than prior studies. This study demonstrated that regular screening before and during OIT is associated with a reduced rate of EoE. Yet, EoE remains a potential adverse effect of OIT and clinicians should be mindful that patients undergoing OIT with more numerous, severe, and persistent gastrointestinal symptoms may be at higher risk for EoE.