The role of allergy evaluation in adults with eosinophilic esophagitis

Joshua D Penfield, David M Lang, John R Goldblum, Rocio Lopez, Gary W Falk
Journal of Clinical Gastroenterology 2010, 44 (1): 22-7

BACKGROUND: Allergy evaluation and skin prick testing for foods are recommended in all patients with eosinophilic esophagitis. However, the yield of allergy evaluation in adult eosinophilic esophagitis is not known.

GOALS: To determine the yield of allergy evaluation in adults with eosinophilic esophagitis.

STUDY: All adult patients in the Cleveland Clinic eosinophilic esophagitis registry between January 2006 and April 2008 were identified. Diagnosis was based on clinical presentation and endoscopy with biopsies showing > or = 15 eosinophils/hpf. From this group, all patients referred for allergy evaluation were identified. Allergy evaluation consisted of skin testing to foods in all patients. Selected patients underwent skin testing to inhalants based on the presence of concomitant allergic rhinitis and/or asthma. Immediate hypersensitivity skin testing was performed and scored by standard methodology. Patients were referred on an ad hoc basis by the gastroenterologist and not based on a priori identification of an allergic diathesis.

RESULTS: Twenty-six out of 68 patients (38%) completed allergy evaluation. Thirteen out of 26 patients (50%) demonstrated a positive skin test to > or = 1 food allergen. Of the 15 patients who underwent skin testing for inhalants, 14 (93%) had a positive skin test to 1 or more inhalants. In total 21/26 patients (81%) had > or = 1 allergen identified, 16/26 (62%) had > or = 5 allergens identified, and 4/26 (15%) had > or = 10 allergens identified (range: 0 to 20 allergens identified). Peanut, egg white, soybean, cow's milk, and tree nuts were the most common food allergens identified.

CONCLUSIONS: Allergy evaluation has a high yield in adult eosinophilic esophagitis as 81% of referred patients had one or more allergens identified and 50% had one or more skin tests positive to foods. Allergy evaluation should be considered in adult patients with eosinophilic esophagitis.

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