An Allergic Phenotype and the Use of Steroid Inhalers Predict Eosinophilic Oesophagitis in Patients with Asthma

Harer KN, Enders FT, Lim KG, Alexander JA, Katzka DA

BACKGROUND: Patients with eosinophilic oesophagitis (EoE) commonly have asthma and atopy. AIMS: To determine the predictive factors of EoE in patients with asthma.

METHODS: A retrospective analysis of a large database identified 156 asthma patients with EoE and 276 patients without EoE between 2000 and 2010. Clinical and laboratory characteristics were first analyzed in half of each group. Significant differences and modelling were then applied to the other half of each group in a split half analysis.

RESULTS: Odds ratios and P-values found to predict the presence of EoE in asthma patients were: allergic vs. non-allergic asthma (4.07,<0.01), food allergies (45,<0.01), allergic rhinitis (2.13, =0.01) and peripheral eosinophilia (4.51,<0.01). The use of inhaled corticosteroids was negatively associated with EoE (0.41,<0.01) for asthma patients and (0.37, P < 0.01) for allergic type asthma patients. EoE patients were also younger (27.4 vs. 41.6 years old, P < 0.01). By logistic regression analysis, allergic asthma, presence of peripheral eosinophilia and use of inhaled steroids remained significant. From these parameters, a 3.5-point scoring system model for EoE in asthma was formed with an ROC = 0.787 on split analysis.

CONCLUSIONS: In descending order, peripheral eosinophilia, allergic asthma and allergic rhinitis are associated with EoE in patients with asthma. Steroid inhalers appear to have a protective effect against EoE. An accurate and simple scoring system can be used as a screening tool to predict the presence of EoE in patients with asthma and dysphagia. EoE should be viewed as part of a generalised allergic phenotype rather than isolated oesophageal disease.