Prevalence and Predictors of Eosinophilic Esophagitis (EoE) Among Children With Severe Asthma.

Abstract

Although previous studies have found an association between eosinophilic esophagitis (EoE) and asthma, no studies to date have assessed the prevalence or predictors of EoE among children with severe asthma. To assess the prevalence and predictors of EoE among children with severe asthma. This was a cross-sectional study of children with recurrent wheeze/severe asthma who underwent bronchoscopy for respiratory symptoms and esophagogastroduodenoscopy for gastrointestinal symptoms. EoE cases were defined according to consensus guidelines. Diagnostic tests included bronchoalveolar lavage for cell count/differential and measurements of blood absolute eosinophil count (AEC) and total IgE. Differences in demographic and clinical characteristics were compared using χ² tests and the Student t test; predictors of EoE were assessed using logistic regression and receiver-operating characteristic curves. A total of 214 children with problematic wheeze or poorly controlled asthma and gastrointestinal symptoms were included. EoE prevalence was 23.4%. EoE was associated with bronchoalveolar lavage eosinophilia (odds ratio, 2.61; 95% CI, 1.13-6.00; P = .001), but this did not persist in adjusted analyses. Patients with coexisting EoE had a higher prevalence of allergic comorbidities and higher blood AEC (672.0 ± 1043.4/μL vs 235.4 ± 216.9; P < .001). AEC demonstrated high diagnostic accuracy for EoE when used in combination with the presence of allergic comorbidities. A high prevalence of coexisting EoE was found in pediatric patients with severe asthma. Those with severe asthma with EoE were more likely to have other allergic conditions and higher blood AEC levels. Future studies should evaluate whether AEC can be used to screen for EoE among children with severe asthma.