When it comes to conditions that an allergist/immunologist treats, we most often think of nasal allergies, asthma, food allergies, as well as skin rashes, and immune disorders. But there is a chronic inflammatory condition of the esophagus you may not have heard of – and cases are on the rise.
Eosinophilic esophagitis (EE or EoE) is a lifelong allergic/immune condition that causes inflammation in the esophagus. The esophagus is the tube that connects your throat and stomach, delivering food and liquid to your body. In EoE, large numbers of white blood cells, called eosinophils, are found in the lining of the esophagus resulting in inflammation. This chronic inflammation leads to symptoms. EoE can be triggered by a food allergy, acid reflux, or an airborne (seasonal) allergy.
What are the Symptoms of Eosinophilic Esophagitis?
The main symptom of EoE is difficulty swallowing. Other symptoms of EoE can vary with age:
- Infants and toddlers may refuse to eat and therefore not grow properly.
- School age children may show a decrease in appetite, recurring abdominal pain, trouble swallowing, and vomiting.
- Teens and adults can have the same symptoms but will most often complain of difficulty and pain in swallowing, especially with dense, dry foods.
People with EoE may feel the need to drink a lot of fluids to help swallow and often feel full and unable to finish a meal. The pain and difficulty in swallowing occurs due to inflammation in the esophagus. In severe cases, the esophagus narrows to the point where food gets stuck. This is called a ‘food impaction’ and can result in a medical emergency.
Some patients may experience reflux, when acid from the stomach backs up into the esophagus, causing a burning sensation or chest pain. It is important to note that eosinophils can be present in the esophageal tissue in other diseases other than EoE. One example is acid reflux. These diseases must be ruled out before making an accurate diagnosis of EoE.
Who is at Risk for Eosinophilic Esophagitis?
Most people with EoE are atopic, meaning they have symptoms of one or more allergic disorders. These allergic conditions include allergic rhinitis, asthma, atopic dermatitis (eczema), and food allergy. About half of people with EoE also have seasonal allergies or asthma and notice their EoE symptoms get worse during the times of the year they experience seasonal allergy symptoms. Others may have food allergies or eczema, and some have a combination of allergic conditions that increase the risk of EoE. About one in four people who have food allergy-induced EoE notice a seasonal variation in their symptoms.
In some cases, there is a genetic component, so having a family member with EoE can also be a risk factor. You can develop EoE at any age, though for reasons not yet understood it impacts three times as many men as women. If left untreated, symptoms cause further damage to your esophagus and, potentially, your overall health.
How is Eosinophilic Esophagitis Diagnosed and Treated?
EoE is a complex disorder that often requires a gastroenterologist and an allergist/immunologist working together to confirm the diagnosis and develop the proper treatment and management plan.
Currently an upper endoscopy and biopsies of the esophagus conducted by a gastroenterologist are necessary to confirm a diagnosis of EoE. This involves passing a flexible tube containing a light source and a camera lens down your throat to allow your doctor to see the tissue more clearly. Tiny samples of tissue can also be collected to detect levels of eosinophils by examining them under a microscope.
An allergist will determine what role allergies are playing in your condition. They may utilize allergy testing along with a thorough history of symptoms during the diagnostic process. Allergy skin prick tests can identify sensitivity to environmental allergens like pollen, mold, pet dander, and dust mites.
Adverse responses to food are the main cause of EoE in many patients. If food(s) are suspected, eliminating the most common triggers may be recommended to see if symptoms improve. Common food triggers include dairy, eggs, peanuts, other tree nuts, wheat, fish and shellfish, and soy products. If allergy testing identifies other food allergies, eliminating those foods may be recommended as well. With EoE, it can be more difficult to establish the role caused by foods since reactions are slower, and a single food may be harder to pinpoint.
Medication Therapies for EoE
The treatment prescribed will depend on what’s triggering your EoE and the severity of your symptoms. In May 2022, the FDA approved the use of Dupixent (dupilumab) in adults and children 12 years and older for treating eosinophilic esophagitis. This is the first medicine to be approved for EoE treatment. This injectable biologic medication reduces inflammation associated with the disease improving the ability to swallow.
Other medications have been used to reduce eosinophils in the esophagus including proton pump inhibitors (PPI’s) which reduce acid production in the stomach, and swallowed inhaled steroids, which control inflammation. Careful monitoring by physicians knowledgeable in treating EoE is important.
After diagnosis, managing EoE will require close collaboration and communication between your allergist and gastroenterologist. For those newly diagnosed, there are additional resources available from American Partnership for Eosinophilic Disorders.
Atlanta Allergy & Asthma physicians are experts in treating allergic conditions, including EoE. The first step in living with eosinophilic esophagitis is an accurate diagnosis. Schedule a visit with one of our specialists online or call us directly at (770) 953-3331.