The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis

doi:10.1067/mai.2002.121458

Journal of Allergy and Clinical Immunology

Volume 109, Issue 2, February 2002, Pages 363-368

https://doi.org/10.1067/mai.2002.121458 Get rights and content

Abstract

Background: Eosinophilic esophagitis is a disease entity in which patients have (1) elevated eosinophils on esophageal biopsy and (2) symptoms of gastroesophageal reflux. The symptoms do not improve on aggressive acid blockade but do improve on elimination diet or corticosteroid treatment, which tentatively links food allergies to this disorder. Objective: The purpose of this study was to identify potential food antigens in eosinophilic esophagitis. Methods: Patients with eosinophilic esophagitis were identified by biopsy. Potential food antigens were identified prospectively by skin prick testing and patch testing, which were performed through use of standard methods. Atopic tendencies, demographics, and potential food allergies were identified. Repeat esophageal biopsies were reviewed when possible. Results: A total of 26 patients (22 male, 4 female) with a biopsied-confirmed diagnosis of eosinophilic esophagitis underwent both skin prick testing and patch testing to identify potential causative foods. Milk and egg were the most common positive foods with skin prick testing. Wheat was the most common positive food with patch testing. The patients were advised to avoid positive foods as identified by skin prick testing and patch testing. In all, 18 patients had resolution of their symptoms, 6 patients had partial improvement, and 2 were lost to follow-up. Overall, after intervention, esophageal eosinophil counts improved from 55.8 to 8.4 eosinophils per high-power field. The foods most commonly identified by patients as causing symptoms were milk and egg. Conclusion: The combination of skin prick testing and patch testing can identify potential causative foods that might contribute to the pathogenesis of eosinophilic esophagitis. (J Allergy Clin Immunol 2002;109:363-8.)

Section snippets

Diagnosis of EE

The diagnosis of EE was made in each of 26 patients (4 girls, 22 boys) who had at least 1 of 4 symptoms—vomiting, regurgitation, abdominal pain, and dysphagia—despite at least a 3-month therapeutic trial of proton pump inhibitors. To make the diagnosis, all patients underwent esophagogastroduodenoscopy, which included biopsies of the esophagus, stomach, and duodenum. At least 3 individual biopsy specimens were obtained from the esophagus. Two biopsies were taken in the distal esophagus (3-5 cm

Demographics

A total of 26 patients with confirmed EE were referred by the Gastrointestinal and Nutrition Department of The Children's Hospital of Philadelphia. The mean age was 6.93 ± 3.48 years (range, 2.38 to 14.3 years; Table I).

. Demographic data (N = 26)

Age (y): mean (range)	6.93 ± 3.48 (2.38-14.357)
Sex: male/female	22/4
Atopy (no. of patients)
Asthma	16
Allergic rhinitis	13
Atopic dermatitis	6
Any atopic diathesis	21
Environmental allergies (no. of patients)	14 of 16

Of the 16 patients who underwent skin prick

Discussion

In this study, we have described for the first time the use of skin prick testing and patch testing to determine potential food antigens as the cause of EE. We studied 26 patients with EE in whom the diagnosis had been confirmed on biopsy and there was a lack of clinical response to aggressive acid suppressive therapy. We found that the elimination of positive foods identified by both skin prick testing and patch testing led to complete resolution of the clinical symptoms in 18 of 24 patients.

Acknowledgements

We acknowledge the referrals from Drs Joel Fiedler and Nicholas Pawlowski from the Allergy Section and Drs Ritu Vermu, Janice Kelly, Edisio Semeao, Kurt Brown, Kathleen Loomes, and Janice Kelly of the Gastroenterology and Nutrition Division of The Children's Hospital of Philadelphia. We also thank Dr Nicholas Pawlowski for his advice and thoughts on patch testing.

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^☆: Supported by Pennsylvania Allergy and Education Research Grant and McCabe Pilot Grant Award (University of Pennsylvania).

^☆☆: Reprint requests: Jonathan M. Spergel, MD, PhD, Wood 5; Allergy Section, Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104.

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Food and Drug Reactions and AnaphylaxisThe use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis☆,☆☆

Abstract

Section snippets

Diagnosis of EE

Demographics

Discussion

Acknowledgements

J Allergy Clin Immunol

Gastroenterology

Gastroenterology

Gastroenterology

Am J Gastroenterol

J Allergy Clin Immunol

J Pediatr

J Pediatr

J Invest Dermatol

Eosinophilic gastroenteritis

J. Pediatr Gastroenterol Nutr

Allergic gastroenteropathy in children

Ann Allergy Asthma Immunol

Food and Drug Reactions and Anaphylaxis
The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis☆,☆☆