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You Down with EoE? No Thanks, Not Me.

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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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OAS—A Seasonal Mess?

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                         Photo copyright©    National Jewish Health   . All rights reserved. Used by permission.

                      Photo copyright© National Jewish Health. All rights reserved. Used by permission.

Ahh, summer. The season of pool parties, barbecues, gardening, and outdoor adventure. For many though, summer also means seasonal allergies. That’s right, runny noses, itchy eyes, and nasal congestion. But how about an itchy mouth?

If you’ve ever bitten into a raw apple, banana, or piece of celery and experienced an itchy mouth, you’re not alone. This reaction occurs because the proteins found in some raw fruits and vegetables are very similar to those found in plant pollen. Your body perceives these similarly structured proteins as pollen allergens – this recognition overlap is also referred to as cross-reactivity. If you’ve experienced this reaction before, you may have oral allergy syndrome (OAS). Or what Allergy Amulet allergist advisor Dr. John Lee calls: The most common allergy you don’t know you have.

So now you’re probably wondering if you’ve ever experienced OAS, right? The most common symptoms include: itchiness or swelling of the mouth, lips, face, tongue, and throat. These symptoms typically appear right after eating raw fruits or vegetables. OAS is considered a mild form of food allergy, and only in very rare instances has OAS resulted in more serious allergic reactions like anaphylaxis.

Now that we’ve defined OAS, let’s take a closer look at which common plant pollens most often cross react with which fruits and vegetables: 

It’s important to note that OAS isn’t limited to the above chart of fruits and vegetables—certain spices, legumes (peanuts and soybeans), and nuts (almonds and hazelnuts), can also bring about OAS symptoms as well.

The good news? Many people affected by OAS can eat the same fruits or vegetables when they are cooked. Heat alters the protein structure in the food so that the immune system no longer recognizes them as similar to pollen proteins. Peeling these fruits and vegetables before eating them can also stave off an OAS reaction, as these proteins are often concentrated in the skin. However, many allergists recommend avoiding the food in raw form altogether if it’s causing symptoms. Alternatively, consider eating canned versions of these nutritious favorites if you can’t resist them, as processing helps destroy the proteins typically involved in OAS.

If you've experienced OAS symptoms after eating a raw fruit or vegetable, it’s wise to talk to your health care provider or allergist. Because standard food allergen tests (skin prick or blood test) often come back negative for people with OAS, a diagnosis is often made when these traditional tests are coupled with a history of OAS symptoms. Some allergists perform what’s referred to as a “fresh prick by prick” test. This entails pricking the raw fruit or vegetable with a skin prick testing device and then pricking the skin of the patient. This test is generally more accurate because the proteins in raw fruits and vegetables are often not as processed as allergy extracts, which are commonly used in traditional skin prick tests.  

Fascinating.

If you have any questions about OAS, let us know! We’re always up for a good allergy chat.

- Meg and the Allergy Amulet Team

 

Allergy Amulet advisors Dr. Jordan Scott and Dr. John Lee have reviewed this piece for accuracy. 

Dr. Scott is an allergist/immunologist and operates several private allergy clinics throughout the Boston area. He is on the board of overseers at Boston Children’s Hospital, and the past president of the Massachusetts Allergy and Asthma Society. Dr. Scott is an allergy/immunology instructor at the University of Massachusetts.

Dr. Lee is the clinical director of the food allergy program at Boston Children’s Hospital and an Instructor in Medicine at Harvard Medical School. He is also the co-creator of AllergyHome.org, a website that offers online resources to help educate and promote awareness about food allergies in schools, camps, and other settings. Dr. Lee is widely recognized for his work in the food allergy space, and his commitment to patient health.

 

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