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• W1936627424 abstract "We read with great interest the article by Jensen et al., where the authors reported a mild seasonal variation, with significantly more cases in late spring and summer months, in a large series of 14 524 patients diagnosed with oesophageal eosinophilia or eosinophilic oesophagitis (EoE).1 These findings have been previously reported by other groups,2, 3 although more recent studies have displayed conflicting results.4, 5 In our long clinical experience with EoE, newly diagnosed cases are present all year around. Here, we would like to expound on a number of reasons addressing why a seasonal variation in EoE might not be true: All available evidence is exclusively based on retrospective studies, with their inherent biases. An EoE diagnosis is established in symptomatic patients after upper endoscopy with oesophageal biopsies. Diagnostic delay since the onset of symptoms is extremely common,6 due to variables related to patients (underestimation of symptoms, avoidance of medical attention or eating behaviour modifications), physicians (lack of suspicion, lack of biopsies during endoscopy) and hospitals (waiting time for endoscopy). As such, equating the onset of clinical manifestations, potentially triggered by seasonal aeroallergens, with the time of performance of the endoscopy may be inaccurate. All of the aforementioned confounding variables are eliminated when EoE is diagnosed due to food impaction. Although a recent study has also reported a seasonal variation in EoE-related food impaction,7 food impaction is usually a consequence of the fibrotic oesophageal remodelling in patients with long-standing EoE.6 Likewise, food impaction during outdoor seasons might also be related to different food and social behaviours during holidays. EoE patients are usually sensitised to indoor perennial aeroallergens8 and de novo onset of EoE has been associated with exposure to mould and dust.9 Thus, conferring a predominant triggering role to seasonal pollen seems overly simplistic. The majority of atopic diseases are related to IgE-mediated reactions that are rapidly triggered after exposition to sensitised allergens. In contrast, EoE constitutes an IgG4-associated food allergy,10 and patients do not show immediate response after exposition to foods triggering the disease. Last, but not least, most EoE patients suffer from atopic conditions with seasonal flares during the pollen season, leading to visits to the allergy clinic. In this context, if the patient also reports chronic mild oesophageal dysfunction symptoms, the opportunity of achieving an EoE diagnosis during the same season is highly likely. Either way, whether a seasonal predominance in the incidence of EoE is true, or merely derives from seasonal diagnostic opportunities, should be elucidated with high-quality prospective studies. Declaration of personal and funding interests: None." @default.
• W1936627424 created "2016-06-24" @default.
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• W1936627424 date "2015-09-02" @default.
• W1936627424 modified "2023-10-18" @default.
• W1936627424 title "Letter: seasonal variation in the diagnosis of eosinophilic oesophagitis - fact or myth?" @default.
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• W1936627424 doi "https://doi.org/10.1111/apt.13357" @default.
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