Prenatal, intrapartum, and postnatal factors are associated with pediatric eosinophilic esophagitis

Publication date: Available online 7 June 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Elizabeth T. Jensen, Jonathan T. Kuhl, Lisa J. Martin, Marc E. Rothenberg, Evan S. Dellon
BackgroundMultiple lines of evidence point to the potential importance of early-life environmental factors in the rapid rise in incidence of eosinophilic esophagitis (EoE), but potential exposures have not been extensively studied.ObjectiveTo assess the association between prenatal, intrapartum, and postnatal factors and the development of pediatric EoE using a case-control study.MethodsCases of EoE were recruited from an existing registry at Cincinnati Children's Hospital Medical Center (CCHMC). Population-based community controls were identified from a separate CCHMC registry. Mothers of study subjects were contacted and completed a web-based questionnaire. Crude and adjusted models were used to estimate associations.ResultsMothers of 127 cases and 121 controls were included. We observed a positive association between several early-life factors and EoE, including prenatal (maternal fever: aOR 3.18; 95% CI 1.27, 7.98; preterm labor: aOR 2.18; 95% CI 1.06, 4.48), intrapartum (Cesarean delivery: aOR 1.77; 95% CI 1.01, 3.09) and infancy factors (antibiotic use: aOR 2.30; 95% CI 1.21, 4.38; use of an acid-suppressant: aOR 6.05; 95% CI 2.55, 14.40). We observed an inverse association between having a furry pet in infancy and EoE (aOR 0.58; 95% CI 0.34, 0.97). No associations were observed for breastfeeding or maternal multivitamin or folic acid supplement use.ConclusionEarly-life factors including maternal fever, preterm labor, Cesarean delivery, and antibiotic or acid suppressant use in infancy were associated with risk of pediatric EoE; having a pet in the home was protective. These results add to growing evidence that implicate early-life exposures in EoE pathogenesis.

Teaser

Heritability estimates for EoE suggest that both genetics and early-life environmental factors contribute to disease pathogenesis. The present study identifies several prenatal, intrapartum, and postnatal factors associated with EoE susceptibility.


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