Eosinophilic esophagitis in a pediatric cohort in Cali, Colombia.
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1
Fundación Valle del Lili, Colombia
Background
Eosinophilic esophagitis (EoE) is an entity of difficult diagnosis and treatment. It is considered an allergic pathology by the underlying immune mechanism. The diagnosis is made with a count of 15 eosinophils per high-power field (HPF) in esophageal biopsies of symptomatic patients (1). The aim of this study was to describe the demographic characteristics and sensitization profile (inhalant and food allergens) in a cohort of patients diagnosed with EoE.
Methods
Prospective observational study. Patients with diagnosis of EoE seen in our clinic (allergy and/or pediatric gastroenterology units) between September 2013 and February 2015 were included. Demographics characteristics and history of atopy in patients and their first-degree relatives were obtained by medical record. Sensitization to food and inhalant allergens were made out with skin prick tests or specific IgE (ImmunoCAP), and eosinophil count in esophageal biopsies taken by endoscopy.
Results
Fourteen patients were included. The median age was seven years. The median age at the onset of symptoms was 5.5 years. Eight (58%) were men. Eleven (71.4%) had a history of atopy in first-degree relatives. Only one patient (7.1%) had a family history of EoE. Twelve (85.7%) had other allergic diseases, being the most prevalent the allergic rhinitis in 11 cases (91.6%), followed by asthma in three (25%) and food allergy in one (8.3%). The main clinical manifestation was gastroesophageal reflux refractory to treatment in nine patients (64.2%), followed by abdominal pain in five (35.7%). 50% of endoscopies were normal macroscopically, and 28.5% of them reported exudates. Specific IgE to inhalant and food allergens was assesed by ImmunoCAP in one patient (7.1%) and by skin prick test in 13 (92.8%). 12 patients (85.7%) had allergic sensitization to inhalants. Dust mites were the most frequently found, being present in 78.5% of cases (D. pteronyssinus in 100% of them). Five patients (35.7%) had sensitization to food, of which two (40%) had sensitization to cow's milk and two to soy. The average count of eosinophils in esophageal biopsies was 36 per high-power field (range 15-52). All patients had previously received proton-pump inhibitor without clinical improvement.
Conclusion
EoE remains a diagnostic and therapeutic challenge. Men were mostly affected and allergic rhinitis the most common comorbidity. The main allergic sensitization that we found was to dust mites, suggesting that, unlike other series, these allergens play a major role in the clinical manifestations and the induction of tissue eosinophilia.
References
Liacouras CA et al. Eosinophilic esophagitis: Updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011; 128: 3-20.
Keywords:
Eosinophils,
Gastroesophageal Reflux,
food allergy,
dust mites allergy,
Rhinitis
Conference:
IMMUNOCOLOMBIA2015 - 11th Congress of the Latin American Association of Immunology - 10o. Congreso de la Asociación Colombiana de Alergia, Asma e Inmunología, Medellin, Colombia, 13 Oct - 16 Oct, 2015.
Presentation Type:
Oral Presentation
Topic:
Allergy
Citation:
Olaya
M,
Botero
V,
Ramirez
LF and
Serrano
CD
(2015). Eosinophilic esophagitis in a pediatric cohort in Cali, Colombia..
Front. Immunol.
Conference Abstract:
IMMUNOCOLOMBIA2015 - 11th Congress of the Latin American Association of Immunology - 10o. Congreso de la Asociación Colombiana de Alergia, Asma e Inmunología.
doi: 10.3389/conf.fimmu.2015.05.00293
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Received:
01 Jun 2015;
Published Online:
15 Sep 2015.
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Correspondence:
Dr. Carlos D Serrano, Fundación Valle del Lili, Cali, Colombia, cdserranoreyes@gmail.com