Seasonal Variation in Histologic and Endoscopic Activity of Pediatric Eosinophilic Esophagitis: A Repeated Endoscopy Cohort

Seasonal Variation of Eosinophilic Esophagitis

Abstract

Objective: The pathogenesis of eosinophilic esophagitis (EoE) is not fully understood, food allergens are considered the primary triggers. Nevertheless, the frequent coexistence of EoE with atopic diseases suggests that aeroallergens may also play an important role in disease development and exacerbation. The aim of this study was to assess the relationship between seasonality and disease activity, as determined by esophageal eosinophil counts and endoscopic findings, in children with EoE.
Methods: This retrospective cohort study included pediatric patients diagnosed with EoE who were followed at our center between January 1, 2010, and June 1, 2026. Demographic, clinical, laboratory, endoscopic, and histopathological data were retrospectively collected from the medical records and analyzed. The spring and summer months were defined as the high-pollen season, whereas the autumn and winter months were defined as the low-pollen season.
Results: A total of 526 upper gastrointestinal endoscopic examinations were performed in the 130 patients during the study period. An accompanying allergic disease was present in 55 patients (42.3%), whereas 75 patients (57.7%) had no history of allergic disease. Asthma was the most common allergic comorbidity, affecting 33 patients (25.4%). Compared with the low-pollen season, the high-pollen season was associated with significantly higher median EREFS scores [2 (interquartile range [IQR], 0-4) vs. 1 (IQR, 0-3), p = 0.012] and significantly higher median peak histologic eosinophil counts [35 (IQR, 0-71) vs. 25 (IQR, 0-60)] eosinophils per high-power field, p = 0.013).
Conclusion: These findings support a potential role for aeroallergens in the seasonal modulation of EoE activity and suggest that seasonal aeroallergen exposure should be considered during the clinical follow-up of pediatric patients with EoE.