A groundbreaking study led by National Jewish Health researchers suggests that the skin may serve as a potential biomarker for a chronic allergic disease of the esophagus called eosinophilic esophagitis (EoE) in children. The results provide physicians a potential new, noninvasive avenue to diagnose EoE by using skin tape.

This study by Elena Goleva, Ph.D. and Donald Y. Leung, MD, Ph.D. of National Jewish Health, in collaboration with Seema Aceves, MD, Ph.D., at the University of California San Diego, focused on ceramides—lipid molecules essential for maintaining the skin’s protective barrier. Results, now published in the Journal of Allergy and Clinical Immunology, demonstrate that the skin of children with EoE but without atopic dermatitis (eczema) show significant deficits in long-chain and ultralong-chain ceramides compared to healthy controls.

“This research provides the first evidence that skin barrier lipid abnormalities exist in EoE, even in the absence of visible skin disease,” said Dr. Goleva. “Our findings support the idea of a unified epithelial barrier dysfunction underlying allergic diseases of both the skin and the esophagus.”

EoE is an inflammatory, food allergen–driven disease characterized by immune-mediated damage to the esophageal lining. It is often seen in patients with other allergic conditions such as eczema and food allergies. However, no reliable surrogate noninvasive markers currently exist for identifying EoE risk—particularly in children without overt skin symptoms.

“This study paves the way for using noninvasive skin tape stripping as a potential diagnostic or screening tool for EoE—eliminating the need for endoscopy,” said Dr. Leung. “By analyzing skin lipid profiles, we may be able to detect epithelial vulnerability before symptoms appear. If validated, this simple skin test could revolutionize how we diagnose and monitor eosinophilic esophagitis.”

The research team used advanced lipidomics analysis via liquid chromatography with tandem mass spectrometry on skin samples collected via tape strips from the forearms of study participants.

The results underscore the possibility that EoE and eczema—while manifesting in different tissues, share a common origin in defective lipid metabolism and epithelial barrier dysfunction. This new research has broader implications for treating and monitoring allergic diseases in childhood.