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Sirs,

We are most appreciative of the interest in our study from Philpott et al., and the important issues they raised concerning our paper.[1, 2] As regards their first point, this is important as we know from population studies undergoing endoscopy screening that subclinical cases of eosinophilic oesophagitis clearly exist. On the other hand, the prevalence is likely low, found to occur in 0.4% of Swedish patients undergoing endoscopy for abdominal pain.[3] Although we suspect the prevalence of asymptomatic eosinophilic oesophagitis would be higher in the asthma population, we would hope it was low enough to not confound our results.

Their point about the influence of gastro-oesophageal reflux disease is also well made, and is a potential confounder. On the other hand, those factors identified on multivariate and split analysis, such as peripheral eosinophilia, lack of steroid inhaler use and presence of intrinsic asthma are not associated with gastro-oesophageal reflux.

As regards their next point, we agree with the mechanism by which symptomatic food allergy associated with an IgE response is not the likely mechanism of eosinophilic oesophagitis. On the other hand, eosinophilic oesophagitis is strongly associated with other manifestations of allergy including IgE-mediated allergic diseases such as food allergy and asthma and therefore we feel the association is valid. We also agree that IgE-mediated food allergy may be one of the strongest indicators of the presence of eosinophilic oesophagitis in asthma patients. In our prospective study, we will feel more secure evaluating this factor when we can be more rigid as regards its definition in patients.

Finally, there is no question that a prospective analysis will help us further validate the use of this scoring system. On the other hand, we attempted to do this in some way by applying our scoring system to an equivalent population used in the split analysis. This analysis further established the validity of our scoring system which we hope establishes consideration for its current use.

It should also be noted that, although the proposed use of this scoring system is one of the key messages of this study, we sought to deliver an even stronger message: the consideration of eosinophilic oesophagitis as a disease that needs to be considered by other subspecialites such as pulmonary medicine. As gastroenterologists, we need to consider other organs, perhaps those in close proximity to the oesophagus, that might be part of the potentially systemic associations of this disease.

Acknowledgement

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  2. Acknowledgement
  3. References

The authors’ declarations of personal and financial interests are unchanged from those in the original article.2

References

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  2. Acknowledgement
  3. References