Is there a correlation between Eosinophilic Esophagitis (EoE) and seasonal allergies?

Correlation Between Eosinophilic Esophagitis (EoE) and Seasonal Allergies

Yes, there is a significant correlation between eosinophilic esophagitis (EoE) and seasonal allergies, with evidence showing seasonal variation in EoE symptoms and diagnosis that corresponds with periods of high aeroallergen exposure. 1

Epidemiological Association

• Rates of allergic rhinitis in patients with EoE range from 40% to 75%, demonstrating a strong association between these conditions 1
• EoE is associated with other atopic diseases including allergic asthma, rhinitis, and eczema, suggesting shared pathophysiological mechanisms 1
• The prevalence of EoE has been increasing throughout the Western world, similar to the increasing trends seen in other allergic conditions 1

Seasonal Variation in EoE

• Multiple studies document seasonality associated with EoE diagnosis, suggesting a potential inciting role for aeroallergens in patients with EoE 1
• There are links to EoE flares during pollen season and spring or summer months, associated with increased aeroallergen exposure 1
• In one study, 71% of EoE exacerbations occurred during fall and summer months, when certain aeroallergen levels are typically higher 2
• A correlation has been observed between peak levels of grass pollen and peak onset of EoE symptoms, which were both highest in July to September 3

Pathophysiological Connection

• Experimental EoE models show that perennial household allergens (dust mite and cockroach) and molds can induce esophageal eosinophilia 1
• EoE pathogenesis is characterized as a TH2-associated disease with increased levels of esophageal mast cells, IL-13, IL-5, TGF-β1, IgE, and FcεRI-positive cells - similar to the immune profile seen in allergic rhinitis and asthma 1
• Esophageal remodeling in EoE appears to follow a process pathogenically similar to asthma 1

Clinical Evidence of Seasonal Impact

• A retrospective study found that significantly fewer patients were diagnosed with EoE in winter (a season of low outdoor allergens) compared to spring, summer, and fall 4
• In a cohort of 1,180 pediatric EoE patients, 14% were suspected of having aeroallergen-associated triggers by history, and 20% of these had biopsy-confirmed variation of EoE triggered by aeroallergens 5
• Among patients with seasonal exacerbations of EoE, 31% reported worsening of seasonal allergies during these periods 2

Clinical Implications

• A thorough evaluation by an allergist or immunologist is recommended for EoE patients due to the high rates of concurrent allergic conditions and the potential seasonality of EoE 1
• Identification of environmental allergens in sensitized patients is important and can guide therapy, particularly in managing seasonal exacerbations 5
• Clinicians should consider aeroallergens as a potential cause of disease exacerbation in EoE patients 2
• Additional testing for asthma and allergies is recommended to improve the diagnosis and control of concurrent atopic diseases in EoE patients 1

Caveats and Limitations

• Definite conclusions on the causal association of seasonality and aeroallergen exposure are difficult to establish due to the retrospective nature of most reports 1
• There is a lack of mechanistic correlation between seasonal associations and the immunobiology of EoE in many studies 1
• Seasonal exacerbations of EoE were found to be uncommon in some cohorts, suggesting this pattern may not be universal among all EoE patients 2
• There is currently insufficient information to support the clinical utility of any single peripheral marker to function as a surrogate disease indicator of histologic inflammation in patients with EoE 1