The “Other” Food Allergy: Eosinophilic Esophagitis

eosinophilic esophagitisEosinophilic Esophagitis (EoE) is a rare allergy and immune disorder that causes inflammation of the esophagus, the tube that leads from the mouth to the stomach. While occasionally caused by acid reflux and other diseases, EoE is a chronic condition that is often caused by an allergic reaction to food.

Currently, only about one in 2,000 people has EoE, but that number appears to be rising, a trend that seems only partly due to increased awareness, and could be related to the rise in food allergies. This condition can develop at any point in a person’s life, affecting adults and children alike, although men are more often affected than women. Unlike food allergies, which are characterized by the release of Immunoglobulin E, EoE is characterized by the presence of eosinophils, which are white blood cells that are part of the immune system. Normally beneficial, these cells play a role in severe asthma attacks and allergic reactions. In EoE, a large number of eosinophils are present in the esophagus, where they do not normally occur, causing extensive tissue damage.

Symptoms

Symptoms of EoE include throat pain and swelling, difficulty swallowing and heartburn. Young children with EoE may refuse to eat, lose weight or show signs of failure to thrive. EoE can occur with a conventional food allergy, so allergic reaction symptoms, such as hives, may also be present.

Diagnosis

EoE is diagnosed through an esophagus endoscopy as well as a biopsy. During the endoscopy, doctors look for inflammation, tissue damage and the presence of eosinophils, the trademark of EoE. The official diagnosis is usually made by a gastroenterologist.

EoE and Food Allergies

After an EoE diagnosis is made, doctors will then look into a patient’s history, particularly any history of food allergies, even if those food allergies were outgrown. The same goes for any family history of food allergies or food sensitivities, since any of these are likely to be the culprit causing those painful EoE flare-ups.

Recently, a study conducted at the Children’s Hospital of Philadelphia found that some children who outgrow their food allergies develop EoE in reaction to that same food later on in life. This study was the first to find a link between outgrown food allergies and EoE. Study authors discovered that 17 of 425 people with food-triggered EoE had previously outgrown the same food allergy that was causing their EoE flare-ups. The study’s results suggests that kids with food allergies are predisposed to developing EoE, and that doctors should monitor children who outgrow their food allergies more carefully, watching out for signs of EoE later on.

Treatment

Like food allergies, EoE is not a curable condition, and the best form of treatment is avoidance of the allergen. Doctors usually begin by having the patient avoid all trigger proteins. If that doesn’t help, the EoE patient may be put on a specialized diet of an amino-acid formula before re-introducing foods one at a time. In rare instances, EoE may not be triggered by food at all, but by other environmental factors.

To help ease symptoms, doctors can prescribe different anti-inflammatory medications, including liquid corticosteroids. Sometimes, EoE reactions can be so severe that the esophagus swells shut, causing a food impaction, where food gets stuck and the patient is unable to eat. While not immediately life-threatening, this is considered to be a medical emergency, and requires treatment by mechanically dilating the esophagus.

The rise in EoE cases have some doctors alarmed, but greater awareness will at least help bring better support and treatment options for affected families. Hopefully, this rising trend won’t last and EoE will continue to be a rare condition. In the meantime, experts recommend that the families of children with food allergies keep watch for signs of EoE.


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