8 inhalants were measured. Epicutaneous SPTs were performed to 16 foods and 38 inhalant allergens. Patch testing to foods was also performed. IgE-mediated al- lergy was diagnosed if either serum-specific IgE or skin- prick test results were positive, whereas non–IgE-medi- ated allergy was diagnosed if a positive patch test result was found. A streptavidin-based immunoassay was per- formed to determine the presence of cross-reactive car- bohydrate determinants and Helicobacter pylori. RESULTS. Prevalence of food and inhalant allergy was 80%. The most common symptoms were dysphagia, vomiting, and abdominal pain. Food-specific IgE test results were positive to food more often than were SPT results, most commonly to milk. Serum-specific IgE de- tected sensitization to food in 42% of patients without a diagnosis of food allergy. Food and inhalant allergies were found with similar frequencies. Almost one-third of patients had multiple sensitivities (tree nuts, peanut, pollen, soy, and grains). Recent studies revealed allergy to plant and mammalian-derived cross-reactive carbo- hydrate determinants, and 3 patients were found to have a positive result (2 to bromelain and 1 patient to galactose--1,3-galactose). Patch-testing results were positive for more than one-third of the patients, most commonly to rye, without correlation to either serum- specific IgE or SPT results. CONCLUSIONS. The majority of patients with eosinophilic esophagitis are atopic. The use of serum-specific IgE to foods might be useful, in particular to milk. REVIEWER COMMENTS. The treatment of patients with eosin- ophilic esophagitis is challenging. The authors found that almost half of the patients were identified to have sensitization to a previously undiagnosed food allergen. Although the clinical significance of the serum-specific IgE might be argued, elimination diets for most patients with eosinophilic esophagitis leads to improvement. This study provides insight into another diagnostic modality, frequently used in the diagnosis of other allergic condi- tions, that might aid clinicians in the diagnosis and treat- ment of patients with eosinophilic esophagitis. However, more correlation with response to elimination of specific foods is needed. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2011–2107CC Vivian Hernandez-Trujillo, MD Miami, FL Esophageal Subepithelial Fibrosis and Hyalinization Are Features of Eosinophilic Esophagitis Li-Kim-Moy JP, Tobias V, Day AS, Leach S, Lemberg DA. J Pediatr Gastroenterol Nutr. 2011;52(2):147–153 PURPOSE OF THE STUDY. The overlap of clinical and histologic findings between eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) can lead to dif- ficulty distinguishing these 2 conditions. These research- ers sought to determine if subepithelial fibrosis could be a more specific distinguishing histologic feature of EoE. STUDY POPULATION. From 358 esophageal biopsies collected from 1995–2008 in a children’s hospital in Sydney, Aus- tralia, 27 children with EoE and 24 children with GERD were identified. Seventy percent of the patients were male and ranged from 7 months to 16 years of age. METHODS. EoE was defined as 15 eosinophils per high- powered field, whereas GERD biopsies had 15 eosin- ophils per high-powered field. Retrospective chart re- views were performed to assess clinical symptoms, and the presence of subepithelial fibrosis was assessed with esophageal biopsy specimens. RESULTS. Subepithelial fibrosis was observed in 24 (89%) children with EoE and in 9 (38%) children with GERD (P  .0001). Fibrosis in EoE was not associated with lymphoid tissue and was less likely to occur in younger children (1.84 vs 7.02 years; P = .02). CONCLUSIONS. Subepithelial fibrosis was a common finding in children with EoE; it occurred in 89% of the children. Fibrosis was more likely to occur in older children and children with longer symptom duration. REVIEWER COMMENTS. The finding of subepithelial fibrosis in children with EoE has long-term implications. If EoE pathophysiology has any similarity to asthma (which this article suggests), then early recognition and treat- ment to prevent fibrosis and remodeling of the esopha- gus are crucial. Esophageal remodeling might explain why some children with EoE have persistent symptoms despite reduction in eosinophils and why this disease is rarely short-lived. URL: www.pediatrics.org/cgi/doi/10.1542/peds.2011–2107DD Kirk H. Waibel, MD Fort Sam Houston, TX Feeding Dysfunction in Children With Eosinophilic Gastrointestinal Diseases Mukkada VA, Haas A, Creskoff Maune N, et al. Pediatrics. 2010;126(3). Available at: www.pediatrics.org/cgi/content/full/126/3/e672 PURPOSE OF THE STUDY. Feeding dysfunction (FD) is a symp- tom complex commonly associated with neurologic dis- eases, developmental delays, and, occasionally, gastro- esophageal reflux disease. Symptoms might range from abnormal feeding behavior and immature diet prefer- ences to sensory and motor skill deficits. The purpose of this study was to define the prevalence and feeding S110 BEST ARTICLES RELEVANT TO PEDIATRIC ALLERGY AND IMMUNOLOGY by guest on April 20, 2017 Downloaded from