Special Edition October 2018

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Scientists Discover Why So Many Children Born With a Defective Esophagus Develop Severe Food Allergies

While advanced surgery often helps infants survive being born with esophageal atresia (EA), nearly one in five go on to develop a severe form of food allergy called eosinophilic esophagitis (EoE).

This life-disrupting condition can sharply restrict the foods a child can tolerate and can lead to growth disorders and other complications. In the overall population, EoE occurs in less than one in every 2,500 births.

Now a study published today in the Journal of Allergy and Clinical Immunology, sheds light on why EoE develops in this small group of children. The discovery was made by a team of U.S. and Australian experts led by Ting Wen, PhD, and Marc Rothenberg, MD, PhD, at Cincinnati Children’s.

Molecular Signature Detected

Extensive genetic analysis of 110 children who received surgery for EA revealed that those who developed EoE exhibited a similar molecular signature to other children with EoE. The study also found a set of six gene dysregulations leading to more severe EoE. One of those dysregulations, affecting the expression level of ANO1, appears to be associated with higher risk of bolus impaction and stricture development, and may serve as a biomarker for a more severe prognosis.

In the years to come, this finding may lead to tests that could precisely determine which children need the most aggressive interventions to protect their ability to eat. But for now, the findings suggest that doctors who regularly see children born with EA should be increasingly vigilant about detecting emerging food allergy symptoms.

EoE has become increasingly recognized as a disease in the past two decades, in large part due to ongoing research at Cincinnati Children’s led by Rothenberg and colleagues. Earlier recognition of EoE can result in better outcomes from treatment.

Vigilance Urged

Compared to the overall population, a child born with EA is 364 times more likely to develop EoE, Wen says.

“Once a child with EA is surgically repaired, their family doctor and GI/allergy physicians should be aware of this high risk and be vigilant about monitoring changes in food ingestion, food pipe function or food allergy,” Wen says.

For more information about EoE, visit the Cincinnati Center for Eosinophilic Disorders Research.