Small Bites: Updates in Pediatric Eosinophilic Esophagitis at AAAAI 2026, with Benjamin Wright, MD

Oral immunotherapy (OIT) is increasingly used in pediatric food allergy management, but emerging data suggest gastrointestinal adverse effects may be more common—and more clinically meaningful—than previously appreciated.

In this episode of Small Bites of Allergy & Immunology from Contemporary Pediatrics, host Brian Schroer, MD, of Cleveland Clinic Children’s Hospital, speaks with Benjamin L. Wright, MD, of Mayo Clinic Arizona, about new findings from a systematic review and meta-analysis evaluating gastrointestinal (GI) symptoms associated with OIT. The analysis, which included 32 randomized controlled trials drawn from more than 6000 screened citations, provides one of the most comprehensive assessments to date of GI tolerability in this setting.

Across studies, Wright and colleagues identified a consistent signal: approximately 30% to 40% of patients undergoing OIT experience GI symptoms, including oropharyngeal itching, abdominal pain, vomiting, and diarrhea. While objective endpoints such as vomiting showed relatively consistent reporting across trials, subjective symptoms—particularly abdominal pain—demonstrated substantial variability, underscoring the need for standardized symptom capture in future research.

Notably, dysphagia emerged as a clinically relevant finding, with odds estimated to be several-fold higher among patients receiving OIT compared with placebo. Although rates of eosinophilic esophagitis were relatively low (approximately 1%) in these trials, Wright emphasized that rigorous screening protocols in randomized studies may underestimate real-world risk. Dysphagia may therefore serve as an important surrogate marker for undiagnosed or evolving disease, particularly in pediatric populations where symptoms are often underrecognized.

The discussion highlights a critical practice gap: patients frequently normalize behaviors such as excessive chewing or fluid intake during meals, which may mask underlying esophageal dysfunction. As a result, Wright advocates for structured pre-treatment screening—including targeted questions about swallowing behaviors—prior to initiating OIT.

From a management perspective, the conversation reinforces the importance of early intervention when GI symptoms arise. Potential strategies include dose reduction, temporary therapy interruption, and adjunctive treatments such as proton pump inhibitors or biologic agents, though further study is needed to define optimal approaches.

Disclosures for Schroer include Amgen, AstraZeneca Pharmaceuticals, BioCryst, GENZYME Corporation, GSK, LEO Pharma, Novartis Pharmaceuticals, and Regeneron Pharmaceuticals. Wright has no relevant disclosures to report.