Is Eosinophilic Esophagitis Part of the Allergic March?

David A. Hill, MD, PhD


July 27, 2018

Editorial Collaboration

Medscape &

My name is David Hill. I am an attending physician in the Division of Allergy and Immunology at the Children's Hospital of Philadelphia (CHOP). Today I am here to speak with you about some new research from my group on an emerging type of food allergy known as eosinophilic esophagitis (EOE).

EOE is triggered by specific foods and tends to target the esophagus with an allergic type of inflammation. As a result of this inflammation, young children can present with food refusal, pain on swallowing, symptoms of reflux, or even failure to thrive. Older children can have more advanced symptoms, with pain on swallowing or potentially even food impaction in extreme cases.

The recent research that I and my colleagues at CHOP did focused on EOE because, while we understand that it seems to have an allergic pathophysiology, we don't really understand how EOE is connected to the other types of allergies.

As you know, there are at least four major groups of allergic manifestations:

  • Atopic dermatitis, or eczema;

  • Classic anaphylactic food allergy;

  • Asthma; and

  • Allergic rhinitis.

The relationship between these four manifestations has actually been very well studied in a model known as the allergic march.

The allergic march describes how children who have early allergic manifestations, such as eczema or food allergies, are at a higher risk of going on to develop later allergic manifestations, specifically respiratory allergies.

What we were interested in was how EOE fit into this pathophysiologic cascade. We studied a large cohort of more than 130,000 children[1] here at CHOP to determine the likelihood of developing each of these five conditions in individual children. What we found, consistent with other reports, was that children who had eczema early on or classic anaphylactic food allergy were at a higher risk of going on to develop respiratory allergies (asthma and allergic rhinitis).

However, what we also found was that EOE fit into this cascade. Specifically, children who had one or more allergic manifestations in early childhood were at a significantly higher risk—almost a nine times higher risk—of developing EOE later on. Interestingly, we also found that children with EOE were at a higher risk of going on to develop allergic rhinitis compared with healthy peers.

What does this research mean? It means that, indeed, EOE is a late manifestation of the allergic march, and what that means to the practicing clinician is that we need to be on the watch for symptoms of EOE in highly allergic children. In young children, [that might present as] reflux or failure to thrive. Older children [might present with] pain with swallowing, reflux, or, in extreme cases, an episode of food impaction.

I hope that this information is useful to you. Please look below for some links to more information about EOE and this research. Thank you.

Related Resources

News release

Blog post

Patient Information: What Is EOE?

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