Columbus, OH — November 2017
A simple, clinically relevant tool is now available to help predict the presence of esophageal eosinophils in children with nonspecific GI symptoms. It may help provide a timely diagnosis and enable earlier treatment for esophageal eosinophilia — the presence of white blood cells in the esophagus, an indicator for allergic and inflammatory esophageal conditions.
The model, provided in full in a paper released earlier this year by the Journal of Pediatric Gastroenterology and Nutrition, uses food-specific IgE test results and gender to predict the probability of having ≥15 eosinophils/high power field (hpf).
“We noticed that among the patients we see in the Eosinophilic Esophagitis Clinic, many had multiple low level, positive IgE results,” says Elizabeth Erwin, MD, co-director of the Eosinophilic Esophagitis Clinic at Nationwide Children’s Hospital, an attending allergist at the hospital and lead author on the paper. “It was so common that we wondered whether it would be possible to predict a diagnosis of esophageal eosinophilia with those IgE results.”
The study revealed that among patients who have IgE antibodies to four or five foods, the predicted probability of having esophageal eosinophilia is 77 percent among boys and 56 percent among girls. The risk is also elevated in boys with IgE antibodies to one to three foods, where the predicted probability of having ≥15 eosinophils/hpf is 52 percent. The publication provides a simple table indicating whether esophageal eosinophilia is more likely than not, based on patient gender and the number of foods to which they have IgE serum antibodies.
“When symptoms of esophageal eosinophilia are obvious, they are more likely to be recognized. Children undergo EGD and proceed with treatment,” says John Russo, MD, co-director of the Eosinophilic Esophagitis Clinic at Nationwide Children’s, attending gastroenterologist at the hospital and a co-author on the paper. “If you’re on the fence as to whether to treat for reflux or proceed with an EGD, this might tell you whether you want to go ahead with the scope rather than waiting a few months for a follow-up.”
The team retrospectively examined medical records of 119 children with esophageal biopsy and food-specific IgE antibody serum tests for the most common allergens: milk, egg, wheat, soy and peanut. This exploratory cohort was used to develop a statistical model to predict the probability of having ≥15 eosinophils/hpf. The model was then tested using the medical records of an additional 142 patients who had also received IgE testing and biopsies.
Since presenting symptoms can vary widely and morbidity related to esophageal eosinophilia increases when untreated, expediting esophageal biopsy among children most likely to have eosinophils may be useful in the management of children with risk factors.
“This is not a general screening tool,” Dr. Erwin says. “But the model may be helpful for children who present without obvious symptoms — the ones who come in with only abdominal pain or vomiting that’s not specific for traditional food allergies or EoE.”
A team of allergists and gastroenterologists at Nationwide Children’s and other institutions conducted the research. The team has prospective research underway, performing IgE serum testing on children undergoing EGDs to verify the model’s accuracy and further probe the clinical utility of the tool.
“Seeing children with multiple positive IgE serum results and eosinophils in the esophagus is becoming more common,” says Dr. Russo. “If we can identify children who could benefit from earlier EGDs, we have the potential to save them from a lengthy diagnostic journey and treat them appropriately sooner rather than later.”
Erwin EA, Rhoda DA, Redmond M, Ly JB, Russo JM, Hill ID, Platts-Mills TAE. Using serum IgE antibodies to predict esophageal eosinophilia in children.Journal of Pediatric Gastroenterology and Nutrition. 2017 Feb 22. [Epub ahead of print.]