This retrospective cohort study evaluated whether EoE treatment outcomes (symptom response, endoscopic EREFS score, and eosinophil counts) differ based on concurrent nasal/inhaled steroid use or a diagnosis of allergic rhinitis in 473 newly diagnosed EoE patients treated with topical corticosteroids (tCS) and followed up with endoscopy and biopsy.
No significant differences in histologic response were found by nasal/inhaled steroid use (aOR for <15 eos/hpf: 0.96; 95% CI: 0.53–1.74). However, EoE patients with allergic rhinitis had notably higher post-treatment eosinophil counts in spring (41.3 ± 7.4 vs. 20.5 ± 3.3 in other seasons; p=0.01).
- Retrospective design limits causal inference and is subject to selection and documentation bias. - Eosinophil counts in spring were higher among allergic rhinitis patients, but the mechanism (pollen-driven esophageal inflammation vs. reduced adherence) was not established. - Concomitant medication adherence was not directly measured.
Clinicians can safely prescribe nasal or inhaled steroids to EoE patients without concern that these agents will mask or confound topical corticosteroid treatment response. Exercise caution when interpreting follow-up biopsies in spring for patients with allergic rhinitis, as eosinophil counts may be transiently elevated.
