Eosinophilic Esophagitis in black children: An overlooked population?

Published Online: March 31, 2014

Eosinophilic esophagitis (EoE) is an allergic inflammatory disorder characterized by increased eosinophils in the esophagus. The prevalence of EoE has increased over the past decade. However, few studies to date have examined the demographics, and specifically the racial distribution, of EoE in children. Prior data show that more than 80-90% of children with EoE are white. Because of this apparent predominance among white, little is known about the clinical presentation in black children.

In a study recently published in The Journal of Allergy and Clinical Immunology: In Practice, Weiler and colleagues report the results of a retrospective review of all patients younger than 18 years of age consecutively diagnosed with EoE during a two year period at the Children’s National Medical Center (CNMC) allergy clinic in Washington, DC. Presenting symptoms, age at diagnosis, coexisting atopic disease, and laboratory parameters were compared between races.

In striking contrast to the prior literature, most of the fifty patients identified were non-white (42% white, 42% black, 4% Asian, and 12% other). Compared to white children, black children were likely to present with poor weight gain (failure to thrive) and vomiting, and were also more likely to have atopic dermatitis. Black children tended to present and be diagnosed at a younger age, but had a trend towards a longer lag between symptom onset and formal diagnosis. It is unclear whether these differences are attributable to race, however, as most were no longer evident after adjusting for age and socioeconomic status.
Black children comprised a larger proportion of EoE patients in this study than previously reported, and had differing clinical presentations compared to whites. Additional large studies that are inclusive of non- white children are needed to define the true racial distribution of EoE. Until the true racial distribution of EoE is better understood, clinicians should be mindful of this potential diagnosis in young, atopic black children with symptoms of esophageal dysfunction.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

Close-up of pine tree branches in Winter Close-up of pine tree branches in Winter