TBA (26S169)

Aeroallergen Sensitisation Is Associated with Poorer Clinical and Histologic Outcomes in Eosinophilic Esophagitis

Author(s)

O Fagan1, M McElheron1, CL Donohoe1, S McKiernan1, NP Conlon, 1 JC Masterson2

Department(s)/Institutions

1 St James's Hospital, Trinity College Dublin 2 Maynooth University

Introduction

Eosinophilic oesophagitis (EoE) is a chronic Th2-mediated inflammatory disease with strong associations with atopy. The contribution of IgE-mediated sensitisation, particularly aeroallergens, to disease phenotype and outcomes remains unclear.

Aims/Background

To characterise IgE sensitisation patterns in EoE using multiplex microarray (ALEX2) and evaluate associations with clinical phenotype and treatment outcomes.

Method

In this prospective cohort study, 40 patients with EoE underwent serum IgE profiling using ALEX2. Patients were stratified by endoscopic phenotype (inflammatory vs fibrotic/mixed). Clinical, endoscopic (EREFS), histologic (eos/phf), and patient-reported outcomes (DSQ, SHS) were assessed pre- and post-treatment. Raised specific IgE (sIgE) was defined as >15 kUA/L.

Results

Raised total IgE was present in 34/40 patients. Aeroallergens accounted for the highest sIgE levels and were identified in 20 patients. Overall, 28% achieved clinical remission and 60% clinical response. Patients with aeroallergen sensitisation demonstrated worse outcomes, including higher post-treatment eosinophil counts (55 vs 4 eos/phf, p=0.02) and persistently elevated symptom scores. They also had lower rates of clinical remission (15% vs 40%) and were diagnosed at a younger age (17 vs 28 years, p=0.011). No association was observed between aeroallergen sensitisation and fibrosis. Ingested allergen sensitisation was less common (15%) and showed limited impact on outcomes. Symptom burden remained higher in patients with aeroallergen sensitisation despite treatment, independent of phenotype.

Conclusions

Aeroallergen sensitisation is associated with poorer clinical, histologic, and patient-reported outcomes in EoE. These findings suggest a role for aeroallergens in disease activity and highlight their potential utility in prognostication and therapeutic stratification.