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

Background 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. Objective To assess the prevalence and predictors of EoE among children with severe asthma. Methods 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 (BAL) for cell count/differential and measurements of blood absolute eosinophils (AEC) and total IgE. Differences in demographic and clinical characteristics were compared using chi-square and student's t-tests; predictors of EoE were assessed using logistic regression and Receiver Operating Characteristic (ROC) curves. Results 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 BAL eosinophilia (OR 2.61; 95% CI 1.13–6.00; p=0.001), but this did not persist in adjusted analyses. Patients with co-existing EoE had a higher prevalence of allergic comorbidities and higher blood AEC (672.0±1043.4/μL vs. 235.4±216.9; p value<0.001). AEC demonstrated high diagnostic accuracy for EoE when used in combination with the presence of allergic comorbidities. Conclusions We found a high prevalence of co-existing EoE in pediatric severe asthmatics. Severe asthmatics with EoE were more likely to have other allergic conditions and higher blood AEC levels. Future studies should evaluate if AEC can be used to screen for EoE among children with severe asthma.