Laryngospasm and pediatric eosinophilic esophagitis

Objective: Symptoms of pediatric eosinophilic esophagitis (EoE) include dysphagia, emesis, regurgitation and feeding difficulties. This symptom complex has been mistaken for refractory gastroesophageal reflux disease (GERD). Whether EoE and GERD are related is controversial. Recently, EoE has been associated with upper airway manifestations including recurrent sinusitis, cough, wheezing, pneumonia, laryngeal edema, and subglottic stenosis. Laryngospasm secondary to EoE has not been reported. The purpose of this study is to increase the awareness of laryngospasm as a presenting symptom in this population. Methods: A 1-year retrospective chart review of 2 children with laryngospasm as the presenting symptom with endoscopic and histopathologic evidence of EoE. Results: Two patients presented to an otolaryngologist with a history consistent with laryngospasm in addition to GI complaints. Laryngospasm was identified during endoscopy. Both patients presented with GERD and symptoms refractory to medical management. Esophagoscopy and biopsy revealed >20 eosinophils per high power field. Symptoms were completely resolved following oral fluticasone therapy at follow-up. Conclusions: The eosinophilic esophagitis symptom complex includes airway manifestations. Pediatric eosinophilic esophagitis should be considered in the differential diagnosis of patients with laryngospasm, dysphagia and gastroesophageal reflux refractory to treatment.