Nasal and inhaled steroid use does not influence treatment response outcomes in eosinophilic esophagitis

Eosinophilic esophagitis (EoE) guidelines suggest that nasal or inhaled steroids for rhinitis, sinusitis, or asthma may obscure the outcomes of EoE treatment. Few data support this assertion.

To assess whether EoE treatment outcomes vary by nasal or inhaled steroid use or concomitant allergic rhinitis.

We conducted a retrospective cohort study of newly diagnosed patients with EoE treated with a topical corticosteroid, with follow-up endoscopy and biopsy. Extracted variables included a diagnosis of allergic rhinitis, treatment with nasal and/or inhaled steroids, and post-treatment symptoms, endoscopic data, and pathology results. Patients with and without treatment with nasal and/or inhaled steroids were compared. We also compared outcomes by diagnosis of allergic rhinitis and season at follow-up.

Of the 473 patients, 185 (39%) had allergic rhinitis. Post-treatment symptom response (83% vs 77%; P = .37), EoE endoscopic reference score (1.9 ± 1.9 vs 2.3 ± 1.9; P = .07), and eosinophil counts (25.5 ± 41.8 vs 23.0 ± 32.4; P = .38) did not differ by allergic rhinitis status. No differences in histologic responses were found by nasal/inhaled steroid use (adjusted odds ratio for <15 eosinophil/high-power field: 0.96; 95% CI: 0.53-1.74) or in patients with asthma who were on inhaled steroids. Patients with allergic rhinitis had higher post-treatment eosinophil counts in the spring (41.3 ± 7.4 vs 20.5 ± 3.3 in other seasons; P = .01).

Treatment responses did not differ by nasal/inhaled steroid use or by concurrent allergic rhinitis. Patients with allergic rhinitis had a higher post-treatment eosinophil count in the spring. These data support the use of nasal/inhaled steroids in patients with EoE but suggest caution when assessing responses in the spring months.