Aeroallergen, Food and Panallergen Sensitization Patterns in Eosinophilic Esophagitis Patients

Eosinophilic Esophagitis (EoE) has been etiologically associated with egg, milk, and wheat allergy. Non-traditional allergens are being increasingly identified in EoE. We aimed to identify sensitization patterns to aeroallergens and food, and associations with pan-allergens, in an EoE population. A case-series analysis of skin test results from 66 EoE patients meeting IRB/study criteria was performed. Associations between sensitization to pan-allergens, profilin/PR-10 and sensitization to aeroallergens and foods were determined via Chi-square tests. Entomophilous plant extracts (Locust; profilin, Alfalfa; PR-10, and non-native Ailanthus; profilin) were used as pan-allergen markers. 73 % of our EoE patients (aged 2-73 years; mean = 16 years; 56% male) were sensitized to both aeroallergens and food. 18% were sensitized solely to aeroallergens and 1.5% solely sensitized to food. 86.4 % patients were pansensitized (> 3 aeroallergens). Overall, patients were sensitized to an average of 20.4 (SD=14.9) aeroallergens and 6.3 (SD=6.5) foods. Sensitization to egg (12/60, 20%), milk (8/62, 13%) and wheat (4/58, 7%) was less than anticipated, and sensitization to unique, pan-allergen containing foods: mustard (14/36, 39%), sunflower (15/25, 60%), garlic (12/45, 27%), and corn (12/46, 26%) was observed. Sensitization to unusual foods, along with legumes and tree nuts, was significantly associated with sensitization to PR-10 (p<0.05) and profilin pan-allergen markers (p<0.05). Novel findings in our EoE population included: 86.4% of patients were pansensitized to aeroallergens and increased sensitization to unique foods was associated with sensitization to pan-allergens. Increased research into pan-allergen sensitization and cross reactivity to food maybe warranted in highly aeroallergen-pansensitized EoE patients.