1- Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE
2- Unidade de Gastrenterologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE
- XXXV Reunião Anual da SPAIC. Porto, Outubro de 2014 (comunicação)
- European Academy of Allergy and Clinical Immunology Congress 2014. Copenhaga, Dinamarca; 7 a 11 de Junho de 2014 (poster)
- Abstract prize (melhor comunicação em poster – Poster Session “Pediatric allergy I”)
Introduction
Eosinophilic esophagitis is a chronic, immune-mediated disease characterized by symptoms of esophageal dismotility. Food allergy seems to be involved.
Aim
To characterize a pediatric population with diagnosis of EoE and evaluate efficacy of different treatment options.
Methods
We included patients with diagnosis of EoE performed under 18 years. The diagnosis of EoE was made on the presence of symptoms of esophageal dysfunction associated with esophageal eosinophilia in biopsy (>15 eos/hpf) and exclusion of GERD by pH monitoring or lack of clinical and histology improvement after a 8 weeks trial with PPI. Patients performed SPT and specific IgE’s to common food allergens. If sensitization to food was present children started dietary restriction. Children without food sensitization or refusing diet, initiated topical fluticasone propionate 500 mcg bid. After 3-6 months of treatment, clinical and histology revaluation was performed.
Results
68 children were included with male predominance (79%). About 2/3 of patients were atopic . There was a delay between the beginning of symptoms (6,5 ± 4,4 yrs) and age of diagnosis (9,1± 4,6 yrs). GERD symptoms were the usual presentation under 6 years old, while older children complained of dysphagia, food impaction or chest pain. Specific IgE and SPT to at least 1 food was detected in 71% and 46% patients, respectively. Complete remission was achieved in 63/68 (92%) of children. 46 patients went on dietary restriction guided by tests, of whom 14 (30%) achieved clinical and histological remission. Milk was the most common food allergen. Topical fluticasone was a very effective treatment (97% remission), but relapse was often observed after discontinuation.
Conclusions
Food sensitization is a common finding in patients with EoE but efficacy of dietary restriction was low. Non-adherence to diet and difficulties in identify the culprit food by standard tests could explain the above mentioned.
Palavras-Chave: Eosinophilic esophagitis, food allergy, children