Allergic eosinophilic esophagitis (AEE) is incompletely defined and the potential association to a type I allergic response is poorly understood. Comparison of patients with varying degrees of eosinophilic inflammation of the esophageal mucosa may further clarify AEE.

Medical records of 117 patients, from January 2000 to January 2001, with eosinophils on esophageal biopsies were reviewed. Demographics, medical history, and allergy testing results for each patient were collected. Patients were grouped according to eosinophils per high power field: 1-5 (Group 1, n=32), 6-19 (Group 2, n=26), and >20 (Group 3, n=59). Groups were compared using bivariate analysis.

There was no significant difference in the mean ages (8.6, 7.6, and 7.1 years respectively), males (63, 69, and 63% respectively), chief complaint, or symptoms among the 3 groups. The most common presenting symptoms were vomiting (78, 58, and 65% respectively) and abdominal pain (63, 54, and 49% respectively). The groups differed in high peripheral esosinophilia (35, 52.2, and 67.4%; p<0.05). A greater percentage of patients in Group 3 had allergy testing (p<0.001); 73% (25/34) of patients in Group 3 had positive allergy testing to food allergens compared with 43.2% in Group 2 and 25% in Group 1. Personal and family history of atopy was similar between the groups.

History and clinical presentation cannot be used to predict the diagnosis of AEE on esophageal biopsy. Patients with AEE may have an increased incidence of food allergy. Allergic phenotypes were more common in Group 2 than in Group 1, suggesting a continuum of disease.