- D3.539 - Evaluation of Treatment Selection and Response in Patients with Eosinophilic Esophagitis Based on Clinical Findings and Allergy Testing

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by esophageal dysfunction and eosinophil-predominant inflammation. Allergy testing remains a valuable tool in clinical practice for elucidating the etiology of EoE, standardizing follow-up, identifying comorbid atopic conditions, and prioritizing specific foods for elimination diets.

Objective

 This study aimed to evaluate the role of diagnostic allergy tests in selecting elimination diets for EoE and to compare the effectiveness of various clinical and therapeutic approaches.

 Fifty-three patients diagnosed with EoE and followed at the Ankara Etlik City Hospital Pediatric Allergy and Immunology Clinic between October 2022 December 2025, were retrospectively analyzed. Demographic characteristics, clinical presentations, laboratory findings, and treatment responses were evaluated.

Of the 53 patients, 73.6% were male. The mean age at diagnosis was 101.1±8 months (range: 8–213), and symptom onset was 81.7±7.8 months (1–189). The most common presenting symptoms were dysphagia/impaction (52.8%) and nausea/vomiting (15.1%). Concomitant atopic disease was present in 35 patients, and 20 had a history of food allergy. No statistically significant difference in treatment response was found between patients presenting with dysphagia/impaction versus other symptoms. Positivity rates for food specific IgE(sIgE), skin prick tests (SPT), and atopy patch tests were 30%, 15%, and 11%, respectively. Aeroallergen SPT was positive in 16 patients, while sIgE was positive in 19. The mean absolute eosinophil count was 382.07±31/mm³(30–1060), and the median total IgE was 102 IU/mL (IQR: 180.9). Medical monotherapy was administered to 52.8% of cases, while 47.2% received a combination of medical and dietary therapy. Symptom onset was significantly earlier in patients with a history of food allergy (p=0.004). A significant correlation was observed between treatment response and positivity for food and aeroallergen sIgE (p=0.046 and p=0.025, respectively). Patients receiving proton pump inhibitors (PPI) in combination with other therapies showed significantly higher response rates than receiving PPI monotherapy (p=0.029).

While empirical dietary elimination is effective in EoE, allergy test-guided diets may also provide clinical benefits. Supplementing PPI therapy with diet and/or topical steroids significantly improves treatment outcomes. The lower response rates observed in patients sensitized to aeroallergens suggest that seasonal or environmental allergens may trigger esophageal inflammation and contribute to treatment resistance. The presence of atopy and food allergy history is associated with earlier EoE onset. Consequently, gastrointestinal complaints in atopic children should be carefully evaluated for EoE.