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Eosinophilic Esophagitis: a rightful member of the allergic march

Published online: June 25, 2018

The allergic (atopic) march refers to the natural history of allergic diseases as they develop during childhood and adolescence. In children, atopic dermatitis (eczema) tends to occur first, followed by anaphylactic food allergy, and then asthma, and allergic rhinitis. It is thought that early onset disorders predispose to late allergic march diseases, as a result of common genetic and inflammatory pathways. While the concept of the allergic march is not new, researchers are now considering that an additional allergic disease, eosinophilic esophagitis (EoE), an emerging allergic inflammatory disease of the esophagus that is triggered by specific foods and pollens, should also be considered a member of the allergic march.

In a new study published in The Journal of Allergy and Clinical Immunology: In Practice, Hill and colleagues studied the acquisition of allergic diseases in a group of 130,435 children followed from birth into adolescence. They then compared the likelihood of developing EoE in allergic and non-allergic children.

The authors found that consistent with prior studies, presence of early allergic disease correlated with development of late allergic march members. In addition, they found that children with atopic dermatitis, anaphylactic food allergy, asthma, or allergic rhinitis were more likely to develop EoE than healthy children. The more allergic comorbidities a child had, the higher the risk of developing EoE. Finally, patients with EoE were found to develop allergic rhinitis at a higher rate than children without EoE.

This study provides the first evidence that EoE is a late manifestation of the allergic march. In addition to expanding the understanding of a pillar concept in the field of allergy, this work supports the need to actively screen allergic children for EoE symptoms.

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