A novel study of a large inpatient cohort found notable disparities across patients diagnosed with eosinophilic esophagitis (EoE) with comorbid food allergies. Ultimately, it was White male teens and wealthier people with insurance who were found most likely to have a comorbid food allergy.

EoE is a chronic condition that shares the same pathophysiologic mechanisms with immunoglobulin E-mediated food allergies and has been described in the literature as occurring frequently in patients with food allergies. What has been lacking, according to the authors of the study, is statistical validation in large inpatient cohorts.

For their study, Misha Shah, DO, and colleagues examined data on 46,575 patients admitted with EoE from 2016 through 2022, as recorded in the National Inpatient Sample. Shah is an internist at the John H. Stroger Hospital of Cook County in Chicago. The study was published online in PLOS One.

The investigators found that of those inpatients seen for EoE during the study period, 1765 (3.79%) had a milk allergy, making it the most common comorbid food allergy. Further, 1535 (3.30%) had a comorbid egg allergy, 1460 (3.13%) had a comorbid peanut allergy, and 1185 (2.54%) had a comorbid seafood allergy.

“Demographic factors also showed a significant role in the likelihood of EoE among patients with food allergy,” the investigators wrote.

The mean age for all patients with EoE was 36.4 years; however, it was White male teens who were most likely to have a comorbid food allergy. The mean ages for patients with EoE with milk, egg, peanut, and seafood allergy were 13.71 years, 13.16 years, 15.02 years, and 22.06 years, respectively.

Female patients had lower odds of EoE compared to male patients (adjusted odds ratio [aOR], 0.52; P < .001), Shah and colleagues found. Black patients (aOR, 0.47; P = .001) and Hispanic patients (aOR, 0.45; P = .001) with food allergies also had lower odds of EoE compared with White patients. Patients with food allergies aged 45-64 years (aOR, 0.18; P = .001) and those with food allergies who were older than 65 years (aOR, 0.06; P = .001) both had decreased odds of EoE when compared with patients younger than 18 years.

Shah and her coauthors wrote these demographic findings were, “consistent with previous research where studies have shown EoE is three to four times more common in men than in women [and that] the average age of EoE diagnosis is between 30 and 50 years.”

For that reason, Shah and colleagues recommended, “there be further investigation into sex- and age-related differences in EoE progression, which may help better guide management approach and prevention.”

Patients from income quartiles of $86,000 or greater who had food allergies were also observed to have the greatest odds of EoE (aOR, 1.79; P = .001) when compared with the lowest quartile. Private insurance (aOR, 3.09; P = .001) and Medicaid (aOR, 2.34; P < .001) patients with food allergy had increased odds of EoE when compared with Medicare patients.

The study’s investigators suggest their findings may support the development of early screening tools and strategies to aid in timely diagnosis and management of patients with EoE and comorbid food allergies.

“These findings underscore the need for earlier screening in high-risk groups, particularly pediatric males with food allergy,” the investigators wrote.

For Joshua Wechsler, MD, MSci, EoE’s association with food allergy is already known, but what he believes this study adds is the demographic data. “That it is shedding light on the disparities in diagnosis of EoE is very good. This is something that needs to change,” he told Medscape Medical News in an interview. Wechsler directs the Eosinophilic Gastrointestinal Diseases Program at the Lurie Children’s Hospital of Chicago.

“It’s not thought that race contributes to the diagnosis, but there are more White EoE patients, possibly because we are not screening enough in Black and other populations,” Wechsler said.

Wechsler said the number of EoE diagnoses is likely to drop in the coming years, thanks to recent changes in guidance to parents about how to introduce food allergens to their children such as the American Academy of Pediatrics guidelines released in October on early food introduction and patterns of food allergy.

“Peanuts are no longer the number one food allergen. That is the kind of change that will have downstream effects and could reduce the number of EoE cases we see,” Wechsler said.

Shah reported no relevant disclosures. Wechsler disclosed that he is currently a speaker and medical advisor for Regeneron and Sanofi; he is the head of a data monitoring committee at AstraZeneca, and has previously, but not currently, consulted for Allakos, Bristol Myers Squibb, and Ellodi.