Increased prevalence of airway reactivity in children with eosinophilic esophagitis

Nadia L. Krupp, Sarita Sehra, James E. Slaven, Mark Kaplan, Sandeep Gupta, Robert Tepper

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Rationale: Asthma is prevalent in children with eosinophilic esophagitis (EoE) estimated at 24-42% in prior studies versus 9% for the general population. However, pulmonary function and airway hyperresponsiveness (AHR) in children with EoE have not been previously defined. Methods: A cross-sectional prospective study was conducted of children ages 7-18 years with EoE and healthy controls. Methacholine bronchial challenge and exhaled nitric oxide were assessed. As measures of atopy and immune activation, peripheral blood was analyzed for total IgE, specific IgE to selected aeroallergens, eosinophil count, and serum cytokines including eotaxin. Results: EoE subjects (n=33) and healthy controls (n=37) demonstrated similar, normal baseline spirometry. AHR occurred in 33% of children with EoE and 11% of healthy controls (P=0.04; 95% confidence intervals [19%, 52%] and [4%, 26%], respectively). The majority of EoE subjects with AHR had no prior diagnosis of asthma. Overall, 69.7% of EoE subjects had either asthma or AHR. For EoE subjects, total serum IgE was the only biomarker associated with a greater risk of AHR (OR=9.643, 95%CI 1.633, 56.925). EoE subjects with and without asthma were similar to healthy controls in mean levels of serum cytokines (IL-5, IL-9, EGF, FGF-2, eotaxin). In exploratory analyses, the subgroup with EoE and asthma without asthma controller therapy had higher mean FGF-2 than EoE subjects without asthma (110pg/ml vs. 65pg/ml, P=0.0426). Conclusions: Asthma and AHR may be more prevalent than previous estimates in children with EoE. For subjects with EoE, elevation in serum IgE was associated with a greater risk of AHR.

Original languageEnglish (US)
JournalPediatric Pulmonology
DOIs
StateAccepted/In press - 2015

Fingerprint

Eosinophilic Esophagitis
Asthma
Immunoglobulin E
Fibroblast Growth Factor 2
Serum
Interleukin-9
Cytokines
Methacholine Chloride
Spirometry
Interleukin-5
Epidermal Growth Factor
Eosinophils

Keywords

  • Allergy
  • Asthma and early wheeze
  • Biomarkers
  • Nitric oxide (NO)
  • Pulmonary function testing

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine

Cite this

Increased prevalence of airway reactivity in children with eosinophilic esophagitis. / Krupp, Nadia L.; Sehra, Sarita; Slaven, James E.; Kaplan, Mark; Gupta, Sandeep; Tepper, Robert.

In: Pediatric Pulmonology, 2015.

Research output: Contribution to journalArticle

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abstract = "Rationale: Asthma is prevalent in children with eosinophilic esophagitis (EoE) estimated at 24-42{\%} in prior studies versus 9{\%} for the general population. However, pulmonary function and airway hyperresponsiveness (AHR) in children with EoE have not been previously defined. Methods: A cross-sectional prospective study was conducted of children ages 7-18 years with EoE and healthy controls. Methacholine bronchial challenge and exhaled nitric oxide were assessed. As measures of atopy and immune activation, peripheral blood was analyzed for total IgE, specific IgE to selected aeroallergens, eosinophil count, and serum cytokines including eotaxin. Results: EoE subjects (n=33) and healthy controls (n=37) demonstrated similar, normal baseline spirometry. AHR occurred in 33{\%} of children with EoE and 11{\%} of healthy controls (P=0.04; 95{\%} confidence intervals [19{\%}, 52{\%}] and [4{\%}, 26{\%}], respectively). The majority of EoE subjects with AHR had no prior diagnosis of asthma. Overall, 69.7{\%} of EoE subjects had either asthma or AHR. For EoE subjects, total serum IgE was the only biomarker associated with a greater risk of AHR (OR=9.643, 95{\%}CI 1.633, 56.925). EoE subjects with and without asthma were similar to healthy controls in mean levels of serum cytokines (IL-5, IL-9, EGF, FGF-2, eotaxin). In exploratory analyses, the subgroup with EoE and asthma without asthma controller therapy had higher mean FGF-2 than EoE subjects without asthma (110pg/ml vs. 65pg/ml, P=0.0426). Conclusions: Asthma and AHR may be more prevalent than previous estimates in children with EoE. For subjects with EoE, elevation in serum IgE was associated with a greater risk of AHR.",
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AU - Krupp, Nadia L.

AU - Sehra, Sarita

AU - Slaven, James E.

AU - Kaplan, Mark

AU - Gupta, Sandeep

AU - Tepper, Robert

PY - 2015

Y1 - 2015

N2 - Rationale: Asthma is prevalent in children with eosinophilic esophagitis (EoE) estimated at 24-42% in prior studies versus 9% for the general population. However, pulmonary function and airway hyperresponsiveness (AHR) in children with EoE have not been previously defined. Methods: A cross-sectional prospective study was conducted of children ages 7-18 years with EoE and healthy controls. Methacholine bronchial challenge and exhaled nitric oxide were assessed. As measures of atopy and immune activation, peripheral blood was analyzed for total IgE, specific IgE to selected aeroallergens, eosinophil count, and serum cytokines including eotaxin. Results: EoE subjects (n=33) and healthy controls (n=37) demonstrated similar, normal baseline spirometry. AHR occurred in 33% of children with EoE and 11% of healthy controls (P=0.04; 95% confidence intervals [19%, 52%] and [4%, 26%], respectively). The majority of EoE subjects with AHR had no prior diagnosis of asthma. Overall, 69.7% of EoE subjects had either asthma or AHR. For EoE subjects, total serum IgE was the only biomarker associated with a greater risk of AHR (OR=9.643, 95%CI 1.633, 56.925). EoE subjects with and without asthma were similar to healthy controls in mean levels of serum cytokines (IL-5, IL-9, EGF, FGF-2, eotaxin). In exploratory analyses, the subgroup with EoE and asthma without asthma controller therapy had higher mean FGF-2 than EoE subjects without asthma (110pg/ml vs. 65pg/ml, P=0.0426). Conclusions: Asthma and AHR may be more prevalent than previous estimates in children with EoE. For subjects with EoE, elevation in serum IgE was associated with a greater risk of AHR.

AB - Rationale: Asthma is prevalent in children with eosinophilic esophagitis (EoE) estimated at 24-42% in prior studies versus 9% for the general population. However, pulmonary function and airway hyperresponsiveness (AHR) in children with EoE have not been previously defined. Methods: A cross-sectional prospective study was conducted of children ages 7-18 years with EoE and healthy controls. Methacholine bronchial challenge and exhaled nitric oxide were assessed. As measures of atopy and immune activation, peripheral blood was analyzed for total IgE, specific IgE to selected aeroallergens, eosinophil count, and serum cytokines including eotaxin. Results: EoE subjects (n=33) and healthy controls (n=37) demonstrated similar, normal baseline spirometry. AHR occurred in 33% of children with EoE and 11% of healthy controls (P=0.04; 95% confidence intervals [19%, 52%] and [4%, 26%], respectively). The majority of EoE subjects with AHR had no prior diagnosis of asthma. Overall, 69.7% of EoE subjects had either asthma or AHR. For EoE subjects, total serum IgE was the only biomarker associated with a greater risk of AHR (OR=9.643, 95%CI 1.633, 56.925). EoE subjects with and without asthma were similar to healthy controls in mean levels of serum cytokines (IL-5, IL-9, EGF, FGF-2, eotaxin). In exploratory analyses, the subgroup with EoE and asthma without asthma controller therapy had higher mean FGF-2 than EoE subjects without asthma (110pg/ml vs. 65pg/ml, P=0.0426). Conclusions: Asthma and AHR may be more prevalent than previous estimates in children with EoE. For subjects with EoE, elevation in serum IgE was associated with a greater risk of AHR.

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KW - Pulmonary function testing

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