Risk of Developing Eosinophilic Esophagitis Is Higher in Pediatric Patients With Atopic Conditions

The risk of developing eosinophilic esophagitis (EoE) was observed to be higher in patients with certain atopic conditions, including asthma, allergic rhinitis, atopic dermatitis, and food allergies, according to new data presented at the American College of Allergy, Asthma, and Immunology (ACAAI) Annual Scientific Meeting in Boston.¹

Eosinophilic esophagitis can cause inflammation of the esophagus. | Image Credit: © INT888 | stock.adobe.com

EoE, a chronic antigen-mediated disorder that can lead to esophageal dysfunction, is frequently seen in atopic patients, affecting about 1 in every 2000 people. The condition is becoming increasingly recognized as a major cause of difficulty swallowing in adults and children.²

This trial, utilizing the TriNetX US Collaborative Network, retrospectively identified pediatric patients aged 1 to 18 years with a diagnosis of any of the 4 conditions to examine whether the patients had a higher likelihood of developing EoE.¹

Patient data from 2016 to 2018 was gathered, with separate analyses run for each diagnosis. Control patients consisted of those without the atopy diagnosis who had any documented International Classification of Diseases-10 (ICD-10) diagnosis.¹

“We did a separate analysis of 4 common allergic conditions—asthma, allergic rhinitis, atopic dermatitis and food allergy—to determine the probability of pediatric patients ages 1 to 18 years with the conditions also developing EoE,” Catherine Haber, MD, lead author of the study, said in a news release.²

“For each of these atopic conditions, we compared the likelihood of developing EoE with a control group of patients who did not have these allergic or atopic conditions,” she continued.”²

In the asthma group, 1885 patients developed EoE and 726 in the control group (HR 2.35; 95% CI 2.16 – 2.56; p-value <0.001). In the allergic rhinitis group, 1444 patients developed EoE compared with 829 in the control group (HR 1.45; 95% CI 1.34 - 1.58; p-value <0.001). In the atopic dermatitis group, 533 patients developed EoE versus 307 patients in the control group (HR 1.53; 95% CI 1.33 - 1.76; p-value <0.001). Lastly, for patients with food allergies, 1098 patients developed EoE compared with 166 in the control group (HR 6.31; 95% CI 5.36 - 7.43; p-value <0.001).¹

“We found that each of these conditions was associated with an increased risk of developing EoE,” Haber said. “We also found that food allergy had the highest risk of developing EoE among the atopic conditions studied.”²

Importantly, the control groups and allergy cohorts were matched regarding race, sex, and ethnicity. They were further matched for the atopic conditions that were included in the trial.²

The results of this trial can help guide pharmacists in the diagnosis and treatment of EoE. Knowing that a patient with a certain atopic condition may have a higher likelihood of developing EoE can guide the management of their condition with appropriate therapies, especially for pediatric patients, who have unique comorbidities and unmet needs when compared to other populations.³

Weight-tiered higher dose dupilumab (Dupixent; Sanofi) has demonstrated significant improvements in children aged 1 to 11 years with EoE compared with placebo in a phase 3 trial. Subcutaneous administration not only alleviated symptoms but improved histological outcomes in pediatric patients.⁴

The fully human monoclonal antibody is approved for the treatment of multiple inflammatory disorders, including atopic dermatitis and asthma.⁴

REFERENCES

1. Haber C, Al-Shaikhly T, Jhaveri P. Risk of developing eosinophilic esophagitis with preexisting asthma, allergic rhinitis, atopic dermatitis, or food allergy. Annals of Allergy, Asthma & Immunology. 2024;133(6):S5-S6. doi:10.1016/j.anai.2024.08.045

2. American College of Allergy, Asthma, and Immunology. Risk of developing EoE high when other allergic conditions factored in. EurekAlert! News Release. Released October 24, 2024. Accessed November 4, 2024. https://www.eurekalert.org/news-releases/1061438

3. McGovern G. Notable comorbidities and unmet needs in pediatric asthma. Pharmacy Times. Published July 18, 2024. Accessed November 4, 2024. https://www.pharmacytimes.com/view/notable-comorbidities-and-unmet-needs-in-pediatric-asthma

4. Gerlach A. Phase 3 trial highlights efficacy of dupilumab for EoE in children aged 1 to 11. Pharmacy Times. Published July 11, 2024. Accessed November 4, 2024. https://www.pharmacytimes.com/view/phase-3-trial-highlights-efficacy-of-dupilumab-for-eoe-in-children-aged-1-to-11