Allergen and Panallergen Sensitization Profile in Pediatric Eosinophilic Esophagitis Patients: a single centre experience

Introduction: Eosinophilic esophagitis (EoE) frequently co-occurs with atopic conditions, suggesting an immune response to environmental antigens in genetically predisposed individuals. This study investigates allergen and panallergen sensitization profiles in a pediatric EoE population Methods: A cross-sectional prospective study was conducted on EoE children followed at V. Buzzi Children's Hospital, Milan, from 10/2022 to 05/2024. Family history and allergic comorbidities were collected; skin prick tests, total and specific IgEs for food, inhalants, and panallergens (profilin, LTP, PR-10) were evaluated Results: 21 children were included (20 males, mean age at diagnosis 11.2, range: 7-15 years) • 17/21 patients (81%) had family history of atopy • 18/21 (85.7%) presented allergic comorbidities, including allergic rhinitis (52.4%), atopic dermatitis (42.9%), asthma (38.1%), food allergy (28.6%) • Total IgEs were elevated in most cases (18/21, 85.7%) • Food-allergen polysensitization (≥3 allergens) was frequent (15/21, 71.4%) notably to wheat (81%), tree nuts (71.4%), sesame (66.7%) • Inhalant sensitization was found in 18/21 (85.7%), mainly to Betulaceae and grass pollen • 14/21 (66.7%) presented panallergen sensitization, with Bet v1 and Phl p12 positive in the majority (10/21, 47.6% for both respectively). Panallergen sensitization was found in 13/17 patients (76.5%) who required transition from PPI to other therapies (elemental diet, topical steroids, biologics), whereas only 1/4 (25%) PPI responders presented panallergen positivity. Conclusion: Pediatric EoE patients show a high prevalence of allergen and panallergen sensitization, the meaning of which is still unknown. Further investigations into sensitization profiles are needed, to explore the specific role of panallergens in EoE pathogenesis, clinical course, and treatment response.