Credit: Ella Olsson

Patients with eosinophilic esophagitis (EoE) are at an increased risk of several different comorbidities, including food allergies, food protein-induced enterocolitis syndrome, and hyper-IgE syndrome.¹

A team, led by Katharine M. Guarnieri, MD, Department of Pediatrics, University of Cincinnati College of Medicine, evaluated the characteristics of patients with allergies both with and without co-existing EoE.

The Data

In the study, the investigators used data from 2 Food Allergy Research and Education (FARE) Patient Registry surveys and evaluated associations between demographic, comorbidity, and food allergy characteristics and the likelihood of reporting EoE using a series of multivariable regression models. Overall, the data from 6074 individuals with a mean age of 20.20 years were included in the final analysis.

In the study, 5% (n = 309) of participants were diagnosed with EoE.

Various demographic and comorbid trends did emerge when the team analyzed the participants.

Trends

For example, being male (adjusted odds ratio [aOR], 1.3; 95% confidence interval [CI], 1.04-1.72) and those with comorbid asthma (aOR, 2.0; 95% CI, 1.55-2.49), allergic rhinitis (aOR, 1.8; 95% CI, 1.37-2.22), and oral allergy syndrome (aOR, 2.8; 95% CI, 2.09-3.70) were associated with a higher likelihood of developing EoE when adjusting for demographics, including sex, age, race, ethnicity, and geographic location.

The same was also true for food protein-induced enterocolitis syndrome (aOR, 2.5; 95% CI, 1.34-4.84) and hyper-IgE syndrome (aOR, 7.6; 95% CI, 2.93-19.92).

However, the results were different for atopic dermatitis (aOR, 1.3, 95% CI, 0.99-1.59).

The results also show a greater risk of EoE, even after controlling for demographics, for individuals with a greater number of food allergies (aOR, 1.3; 95% CI, 1.23-1.32), more frequent food-related allergic reactions (aOR, 1.2; 95% CI, 1.11-1.24), previous anaphylaxis (aOR, 1.5; 95% CI, 1.15-1.83), and healthcare utilization for food-related allergic reactions (aOR, 1.3; 95% CI, 1.01-1.67), particularly intensive care unit (ICU) admission (aOR, 1.2; 95% CI, 1.07-1.33).

However, there was no significant difference in ever using epinephrine for food-related allergic reactions found.

“These self-reported data showed that co-existing EoE is associated with an increased number of food allergies, food-related allergic reactions per year, and measures of reaction severity, calling attention to the likely increased healthcare needs of food allergic patients with EoE,” the authors wrote.

Dupilumab

Up until 2022, there was not an approved US Food and Drug Administration (FDA) treatment for EoE.

However, in May, the FDA approved dupilumab (Dupixent) for the treatment of EoE in adult and pediatric patients 12 years and older weighing at least 40 kg.

Since May, there has been numerous positive reports on the treatment including a study published in the New England Journal of Medicine showing 60% (n = 25) of patients met the primary endpoint of histologic remission who were treated with dupilumab in part A of the three-part, phase 3 trial, compared to 5% (n = 2) of the placebo group (difference, 55 percentage points; 95% CI, 40-71; P <0.001).

The results from part B show histologic remission occurred in 59% (n = 47) of the weekly dupilumab group, 60% (n = 49) of the biweekly dupilumab group, and 6% (n = 5) of the placebo group (difference between weekly dupilumab and placebo, 54 percentage points; 95% CI, 41-66; P <0.001; difference between dupilumab every 2 weeks and placebo, 56 percentage points; 95% CI, 43-69). At baseline, the mean DSQ scores were 33.6±12.41 in part A and 36.7±11.22 in part B.

References:

Guarnieri, K. M., Saba, N. K., Schwartz, J. T., Devonshire, A. L., Bufford, J., Casale, T. B., Rothenberg, M. E., & Andorf, S. (2023). Food allergy characteristics associated with co-existing eosinophilic esophagitis in fare registry participants. The Journal of Allergy and Clinical Immunology: In Practice. https://doi.org/10.1016/j.jaip.2023.02.008