Panallergen sensitization in children with eosinophilic esophagitis: a pilot study

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder associated with atopic comorbidities and may be considered a late manifestation of the atopic march. This study aimed to evaluate the prevalence of atopic comorbidities, sensitization to food allergens and panallergens in pediatric EoE patients, and to explore the potential association between panallergen sensitization and response to treatment.

We conducted a single-center observational study on pediatric EoE patients, followed at Vittore Buzzi Children's Hospital in Milan. Clinical, endoscopic, and histological data, together with sensitization profiles to food allergens and panallergens [profilins, PR-10 proteins, and lipid transfer proteins (LTPs)] were collected. Patients were classified into two groups according to their response to PPI therapy. Group 1 included patients who maintained histological remission on PPIs. Group 2 included patients who either failed to respond to PPI induction therapy or relapsed on maintenance dosing, thus requiring a therapeutic switch.

Twenty-four patients (median age 11.5 years, IQR 9-13; 23 males) were enrolled. 79% (19/24) had a family history of atopy and 19/24 (79%) had allergic comorbidities. Sensitization to food allergens was observed in 17/24 (71%); panallergen sensitization was detected in 15/24 patients (63%). Group 2 showed a significantly higher prevalence of panallergen sensitization (78% vs. 17%, p = 0.015) and atopic dermatitis (56% vs. 17%, p < 0.05) compared to Group 1. Sensitization to profilins and LTPs was associated with lack of PPI response.

This study is the first to address panallergen sensitization in a pediatric cohort of EoE patients. Our findings suggest that panallergen sensitization might be associated with response to PPI. However, these preliminary findings require confirmation in larger, powered studies.