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Essential Screening for Eosinophilic Oesophagitis

A CHRONIC food allergy, eosinophilic oesophagitis (EoO), should be screened for in children with existing allergies, according to new research by allergists at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. With a higher risk of developing EoO as a later component of the ‘atopic march’, children with multiple allergies must be carefully monitored and treated early to reduce the burden of painful oesophageal inflammation.

Although EoO has a low mortality rate compared to life-threatening anaphylactic food allergies, the condition has high morbidity and no obvious trigger, meaning it can be misdiagnosed or persist undiagnosed for a long period. By analysing the health records of a longitudinal cohort of >130,000 patients from birth to adolescence, the team recorded the point at which patients acquired allergic diseases, as well as their risk of developing EoO compared to non-allergic children.

The study results were the first to suggest that EoO is an important component of the atopic march, the concept used to describe the natural progression of many children developing a series of allergies. The team found that patients with three allergies other than EoO were 9-times more likely to develop EoO than children with no allergies. Additionally, EoO was associated with an increased risk of allergic rhinitis; the team therefore concluded that the connection between allergies suggests a common underlying biological cause that requires further study.

Study author, Dr David Hill, Children’s Hospital of Philadelphia, noted that a key takeaway conclusion from this investigation is that primary care physicians should consider screening early for EoO in children who have multiple existing allergies. “Ultimately, we hope to find that intervening earlier in the atopic march, for example, in treating allergic skin conditions, may interrupt the march and prevent the child from developing later disorders such as EoO”, he commented. The next steps in this research will involve investigating the pathogenic pathway of multiple allergies and preventing additional allergies from developing.