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Lendner N, Minich NM, Malay S, Sferra TJ, Young DD. Comparison of budesonide vehicles in inducing histologic remission in pediatric eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 2024; 79:92-99. [PMID: 38803200 DOI: 10.1002/jpn3.12273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/27/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES Oral viscous budesonide (OVB) is a common medication used to treat eosinophilic esophagitis (EoE). It is typically mixed with Splenda to produce a slurry, but other delivery vehicles have been used in clinical practice. We aimed to evaluate outcomes of pediatric EoE patients treated with OVB using different drug delivery vehicles. METHODS We performed a retrospective chart review of pediatric EoE patients treated with OVB. The primary aim was to evaluate rates of histologic remission (defined by <15 eosinophils per high power field in both mid and distal esophagus) after 6-12 weeks of OVB treatment for each delivery vehicle. Secondary aims were to evaluate histologic response and endoscopic response and remission of different delivery vehicles, and to compare the efficacy of different treatment regimens. RESULTS A total of 111 patients were included in the study. Median treatment duration was 3.4 months. Overall rate of histologic remission with OVB was 52.6%. There was no difference in rates of histologic remission (p = 0.313) or response (p = 0.195 and p = 0.681 in mid and distal esophagus, respectively) among the different vehicle types or treatment regimens. Similarly, there was no difference in endoscopic remission and response among the different vehicle types (p = 0.853 and p = 0.727) or treatment regimens (p = 0.244 and p = 0.157). Patients who achieve histologic remission were more likely to be non-Hispanic Caucasian. CONCLUSION Our findings suggest there is no difference in histologic and endoscopic outcomes with various delivery vehicles or combination therapy with OVB in the treatment of EoE. More palatable and cost-effective vehicles can be used to treat EoE.
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Affiliation(s)
- Nuphar Lendner
- Pediatrix Gastroenterology of the Rocky Mountains, Denver, Colorado, USA
| | - Nori Mercuri Minich
- Biostastics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Sindhoosha Malay
- Biostastics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Thomas J Sferra
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Denise D Young
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
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Chehade M, Jensen ET, Wright BL. Addressing health disparities and transitions of care in eosinophilic gastrointestinal diseases. J Allergy Clin Immunol 2024; 153:1526-1528. [PMID: 38593869 DOI: 10.1016/j.jaci.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Departments of Pediatrics and Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Elizabeth T Jensen
- Departments of Epidemiology and Prevention and Internal Medicine, Gastroenterology Section, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Benjamin L Wright
- Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Ariz; Division of Allergy and Immunology, Phoenix Children's Hospital, Phoenix, Ariz
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Bauer M, Nguyen N, Liacouras CA. Clinical Evaluation of the Child with Eosinophilic Esophagitis. Immunol Allergy Clin North Am 2024; 44:157-171. [PMID: 38575215 DOI: 10.1016/j.iac.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The diagnosis of eosinophilic esophagitis (EoE) is based on clinical symptoms of esophageal dysfunction and eosinophil predominant esophageal inflammation. Clinical symptoms in children with EoE vary based on age and may be nonspecific. EoE has a male predominance with the majority having comorbid atopic disorders. At present, treatment options include medications (proton pump inhibition, swallowed topical steroids), dietary therapy or biologic therapy (dupilumab, approved for those ≥12 years of age). Outside of EoE in the context of oral immunotherapy, EoE is typically chronic requiring lifelong therapy. Long-term complications including feeding difficulties, malnutrition, and fibrostenotic disease.
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Affiliation(s)
- Maureen Bauer
- Department of Pediatric Allergy & Immunology, Gastrointestinal Eosinophilic Diseases Program, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 518, Aurora, CO 80045, USA.
| | - Nathalie Nguyen
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Gastrointestinal Eosinophilic Diseases Program, Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 518, Aurora, CO 80045, USA
| | - Chris A Liacouras
- Department of Gastroenterology, Hepatology and Nutrition, Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Muir AB, Bailey DD, Mehta P. Embracing Diversity, Equity, Inclusion, and Accessibility in Eosinophilic Gastrointestinal Diseases. Immunol Allergy Clin North Am 2024; 44:293-298. [PMID: 38575224 DOI: 10.1016/j.iac.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Eosinophilic gastrointestinal diseases (EGIDs) including eosinophilic esophagitis (EoE) are rare diseases in which eosinophils abnormally infiltrate the gastrointestinal tract. Because these are rare diseases, there is limited information regarding race and ethnicity in EGIDs and even less is known about the impact of socioeconomic factors. There is some evidence that access to care in rural settings may be affecting epidemiologic understanding of EGIDs in the pediatric populations. Future work should try to evaluate bias in research and strive for representation in clinical trials and medicine.
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Affiliation(s)
- Amanda B Muir
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Hospital of Philadelphia, 2057 Lombard Street, Philadelphia, PA 19146, USA
| | - Dominique D Bailey
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons/New York-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, New York, NY 10032, USA
| | - Pooja Mehta
- Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, B290, Aurora, CO 80045, USA.
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Jones SM, Anvari S, Coleman A, Pesek RD, Kloepfer KM, Perry TT, Jefferson AA, Doan D, Andres A, Doderer M, Hilbun A, Solomon R, Scurlock AM. Food insecurity and allergic diseases: A call to collective action. J Allergy Clin Immunol 2024; 153:359-367. [PMID: 37926122 DOI: 10.1016/j.jaci.2023.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
Food security encompassess the concept of access by all people at all times to enough food for an active, healthy life. Conversely, food insecurity (FI) refers to household-level economic and social conditions of limited or uncertain access to adequate food. FI is a key social determinant of health that can negatively affect nutrition and health outcomes, as it is estimated that 10.2% of the US population meets criteria for FI. Recognizing the impact of FI on our patients and families is critical to promote health equity and optimize health outcomes. This review focuses on FI and allergic disease from the perspective of key multisector stakeholders within the field of allergy and immunology as well as from the larger health care arena, highlighting key resources and initiatives important to patients. Collectively, as specialists in allergy and immunology, and within the medical field more broadly, we must leverage our unique roles as we interface with patients and families and serve as committed advocates for change. Developing innovative strategies to promote health equity can provide a pathway forward for all children, adults, and families to gain access to healthy, nutritious food as part of their routine lifestyle. This is a call to action.
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Affiliation(s)
- Stacie M Jones
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark.
| | - Sara Anvari
- Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Amaziah Coleman
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Robert D Pesek
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Kirsten M Kloepfer
- Indiana University School of Medicine and Riley Children's Hospital at IU Health, Indianapolis, Ind
| | - Tamara T Perry
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Akilah A Jefferson
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Dieu Doan
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Aline Andres
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Nutrition Center, Little Rock, Ark
| | - Marcy Doderer
- Arkansas Children's Hospital, Little Rock, Ark; Arkansas Children's Health System, Little Rock, Ark
| | - Ashlie Hilbun
- Arkansas Children's Hospital, Little Rock, Ark; Arkansas Children's Health System, Little Rock, Ark
| | - Ryan Solomon
- Arkansas Children's Hospital, Little Rock, Ark; Arkansas Children's Health System, Little Rock, Ark
| | - Amy M Scurlock
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
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Stephen ED, Mahdavinia M. Lessons Learned From Studying Disparities in Eosinophilic Esophagitis Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2860-2861. [PMID: 37684076 DOI: 10.1016/j.jaip.2023.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 09/10/2023]
Affiliation(s)
- Ellen Daily Stephen
- Division of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Ill
| | - Mahboobeh Mahdavinia
- Division of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Ill.
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