Eosinophilic Esophagitis Is a Late Manifestation of the Allergic March

被引:159
作者
Hill, David A. [1 ,2 ]
Grundmeier, Robert W. [3 ]
Ramos, Mark [3 ]
Spergel, Jonathan M. [1 ,2 ]
机构
[1] Univ Penn, Inst Immunol, Perelman Sch Med, Philadelphia, PA 19104 USA
[2] Childrens Hosp Philadelphia, Dept Pediat, Div Allergy & Immunol, Philadelphia, PA 19104 USA
[3] Childrens Hosp Philadelphia, Dept Biomed & Hlth Informat, Philadelphia, PA 19104 USA
关键词
Allergic march; Atopic dermatitis; Food allergy; Allergic rhinitis; Asthma; Eosinophilic esophagitis; GENOME-WIDE ASSOCIATION; ATOPIC-DERMATITIS; FOOD ALLERGY; CHILDREN; ASTHMA; LOCI; PREVALENCE; BIRTH; AGE;
D O I
10.1016/j.jaip.2018.05.010
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
BACKGROUND: The allergic march describes the natural history of allergic conditions as they develop during childhood. Eosinophilic esophagitis (EoE) is a chronic allergic inflammatory disease that can be triggered by specific foods. Despite its allergic pathophysiology, the epidemiologic relationship between EoE and established members of the allergic march is unknown. OBJECTIVE: We sought to determine whether EoE meets epidemiologic criteria for being considered a member of the allergic march. METHODS: Using a primary care birth cohort of 130,435 children, we determined the natural histories of atopic dermatitis (AD), IgE-mediated food allergy (IgE-FA), asthma, EoE, and allergic rhinitis (AR) in individual patients. We then performed case-control analyses to establish the extent that existing allergic conditions influence the rate of subsequent EoE diagnosis. RESULTS: A total of 139 children developed EoE during the observation period (prevalence of 0.11%). The peak age of EoE diagnosis was 2.6 years, as compared with 0.3 years, 1 year, 1.1 years, and 2.1 years for AD, IgE-FA, asthma, and AR, respectively. The presence of AD (hazard ratio [HR] 3.2, 95% confidence interval [CI] 2.2-4.6), IgE-FA (HR 9.1, 95% CI 6.5-12.6), and asthma (HR 1.9, 95% CI 1.3-2.7) was independently and cumulatively associated with subsequent EoE diagnosis. The presence of AR was associated with subsequent EoE diagnosis (HR 2.8, 95% CI 2.0-3.9), and the presence of EoE was associated with subsequent AR diagnosis (HR 2.5, 95% CI 1.7-3.5). CONCLUSIONS: Allergic comorbidities are positively associated with EoE diagnosis. Together, our findings suggest that EoE is a late manifestation of the allergic march. (C) 2018 American Academy of Allergy, Asthma & Immunology
引用
收藏
页码:1528 / 1533
页数:6
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