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Every now and again our team at Allergy Amulet likes to post blogs about lesser-known conditions that affect the food allergy population (our people)! One such blog, I’ll Take My Allergies Medium Rare, covers some uncommon (but very real) forms of allergy. Today’s installment is no different! Have you ever heard of a condition called Eosinophilic Esophagitis (E-o-sin-o-fill-ik Uh-sof-uh-jie-tis), or EoE for short?

What is it?

If you have EoE, a large number of white blood cells (eosinophils) build up in the lining of the esophagus (the tube that connects your mouth to your stomach). This buildup is a reaction to food, airborne allergens, or acid reflux, and can inflame and injure esophageal tissue. EoE is a recognized chronic allergic/immune condition, and is not typically outgrown (but it can be managed)! EoE is a relatively new disease, as it has only been identified in the past two decades. Accordingly, there is still much to learn about this complex condition.

Who does it affect?

EoE affects approximately 1 out of every 2,000 people in the United States. In recent years, allergists and gastroenterologists are seeing an increasing number of patients with EoE—this is presumably due in large part to greater physician awareness about the condition. Most patients with EoE are considered atopic, meaning they have a family history of allergies, asthma, or symptoms of one or more allergic disorders. These can include food allergies, eczema, seasonal allergies, and asthma. For patients with environmental allergies, their EoE may be worse during pollen season. Allergic reactions to food are the main cause of EoE in many patients, and foods such as dairy, soy, wheat, and eggs are often the main culprits. Interestingly, according to Dr. Jordan Scott of Boston Children’s Hospital, the development of EoE has occurred as a side effect of oral immunotherapy for food allergies in up to 3% of cases.

What are the symptoms?

EoE symptoms vary depending on age. Infants and toddlers may refuse food or fail to gain weight. School-age children often experience difficulty swallowing, vomiting, or have recurrent abdominal pain. Teens and adults generally have trouble swallowing, especially dry or dense solid foods. In some cases food can get trapped in the esophagus, which can lead to choking.   

How is it diagnosed?

There are certain criteria for diagnosing EoE that most allergists, gastroenterologists, and pathologists agree on: symptoms consistent with EoE, an upper endoscopy procedure (lets the doctor see what’s happening in your esophagus), and an esophageal biopsy (tissue samples of the esophagus are taken and analyzed). A specialist may also recommend further evaluation (e.g., a gastroenterologist may refer a patient to an allergist for food allergy testing and vice versa).

Is there a silver lining? 

The rise in EoE cases has led to greater physician awareness and further research around the condition. Additionally, a wide variety of treatments have been identified for those managing EoE, such as:

1.    Empiric elimination diet—removing major food allergens (e.g., dairy or wheat) from your diet and gradually adding them back in one at a time under close physician watch and guidance. This diet is often most successful with the help of a dietitian, as it can be tough to manage.

2.    Elemental diet—all sources of protein are removed from the diet and replaced by an amino acid formula, oils, and simple sugars. This treatment is often reserved for children with several food allergies who have not responded to other treatments.

3.    Medical therapy—swallowing small doses of oral corticosteroids has proven effective for managing inflammation. Proton pump inhibitors are also used to control acid production. 

Each of these treatments has its advantages and disadvantages, so it’s helpful to first discuss them with your physician before trying any one approach. One challenge with treatment, according to Dr. Scott, is that patients must typically undergo multiple endoscopy procedures to ensure that esophageal inflammation is improving with meds, dietary avoidance, or both.

The good news is that you don’t have to go it alone! There are numerous support groups and organizations out there that can help, such as APFED and CURED. When it comes to understanding and managing immune conditions, having a trusted support network is key!

- Meg and the Allergy Amulet Team 

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