Markedly Increased Prevalence of Eosinophilic Esophagitis in Patients with Atopic Diseases in a US Veteran Population

INTRODUCTION: Eosinophilic esophagitis (EoE) is a chronic esophageal disorder associated with atopy. However, there are few data on prevalence of EoE in atopic patients. We aimed to determine the prevalence of EoE in atopy and associated demographics, risk factors, and symptoms.

METHODS: A cross-sectional study was conducted with data from the VA population, 2009-2021, using a 9.7% random sample from a nationwide database. Demographics, symptoms, and risk factors were collected on patients at least one atopic condition. Logistic regression models for EoE, allergy, and symptoms were developed.

RESULTS: Of 1,110,189 VA patients, 26% (288,193) had at least one atopic condition and 0.092% (1,022) had an EoE diagnosis. In atopic patients, EoE was most common in patients with milk (4.10%), egg (1.06%), and wheat (0.81%) allergy. Frequency of EoE was lower in patients with asthma (0.26%) and rhinitis (0.22%). Compared to male VA patients without allergy, odds ratio (OR) for EoE was 2.87 for an atopic male, and 3.29 for an atopic female. ORs were increased for EoE in those with milk allergy (OR = 19.9), wheat allergy (OR = 5.94), and egg allergy (OR = 4.10). Of patients with more than one allergic condition, rhinitis and asthma were most likely to increase odds of EoE.

CONCLUSION: The prevalence of EoE is substantially increased in atopic patients, and in particular in patients with food allergy. There should be high clinical suspicion for EoE in a patient with atopic disease and especially milk, wheat, or egg allergy.