Real-world EoE Data Show More, Quicker Responses Among Concurrent Eczema, PFS

Real-world data indicate that eosinophilic esophagitis (EoE) is heterogeneous, with various phenotypes and endotypes that affect how patients respond to treatment.

A new single-center retrospective study included over 130 pediatric patients 18 years or younger with EoE, 80% of which had at least 1 concurrent atopic condition, such as food allergies (57%), eczema (34%), and asthma (29%).

Findings published online in Frontiers in Allergy.

Overall, 65% of patients went into remission throughout the observation period, with those with concurrent eczema having favorable responses. Eighty-one percent of patients with eczema achieved remission, while remission rates were 56% for patients without eczema.

Patients with concurrent eczema went into remission quicker, achieving remission a median of 7 months earlier than those without the condition. Patients who had eczema were younger, had fewer macroscopic findings on their initial endoscopy, and were more responsive to treatment.

“In addition to favorable overall outcomes in EoE patients with eczema, this study shows positive treatment response to PPIs [proton pump inhibitors]. EoE patients with eczema treated with PPIs had higher rates of histologic remission than noneczema patients who were not treated with PPI,” noted the researchers. “There has been significant research into PPI-responsive EoE (PPI-REoE). In 2018 the EoE international diagnosis criteria changed to exclude a PPI trial prior to diagnosis of EoE, allowing for PPIs to be accepted as treatment for EoE and a new group of PPI-REoE patients to exist. Literature shows that 23% to 68% of pediatric EoE patients respond to PPI therapy, with difficulty elucidating what predicts responders vs nonresponders.”

Most of the 55 patients in the current study who were treated with a PPI achieved remission, at 74.5%. Treatment with a PPI was associated with the shortest median time to remission (5.6 months) among patients with eczema compared with patients without eczema (25.5 months)

Patients with concurrent pollen food syndrome (PFS) also had favorable outcomes, with all 7 patients achieving remission, and achieved remission at a quick rate than patients without PFS. Patients with PFS went into remission a median of 10.2 months earlier than patients without the condition.

“There were few patients with PFS in this cohort, reducing our ability to draw general conclusions about these patients,” explained the researchers. “Other studies have noted a strong association between PFS and EoE, including higher rates of PFS in EoE patients. Letner et al looked at 346 adults with EoE and found 26% had concurrent PFS and EoE patients with PFS had higher rates of diagnosis in the Spring. Mahdavinia et al looked at 186 adult EoE patients compared with adults with allergic rhinitis and found that PFS among pollen-sensitized cases was significantly more prevalent in the EoE (51%) compared with allergic rhinitis (10%) group.”

There were no significant differences between rates of remission for patients with and without anaphylaxis, asthma, food allergies, and seasonal allergies rhinitis.

Reference

Sessions J, Purington N, Wang Y, et al. Pediatric eosinophilic esophagitis outcomes vary with co-morbid eczema and pollen food syndrome. Front Allergy. Published online September 2, 2022. doi:10.3389/falgy.2022.981961