Eosinophilic Esophagitis

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Eosinophilic Esophagitis

Eosinophilic esophagitis (EE) is a rare condition that is becoming more common.

Infants with eosinophilic esophagitis will experience vomiting, feeding difficulties, irritability, and poor weight gain. Children complain of vomiting, heartburn and sometimes belly pain. Adults often complain of difficulty swallowing, food impaction and reflux type symptoms.

Eosinophilic esophagitis (EE) is an allergic condition characterized by inflammation of the esophagus (the tube that connects the throat with the stomach). People with this disease have a large number of eosinophils, a type of white blood cell, in their esophagus.

Many patients with eosinophilic esophagitis have a family history of allergies and symptoms of one or more allergic disorders such as asthma, nasal allergies, eczema or food allergy.

Diagnosis
Eosinophilic esophagitis is diagnosed with an endoscopy and biopsy of the esophagus. After the diagnosis of eosinophilic esophagitis has been made, we can then help determine the role allergies are playing with this condition. Most patients are found to have foods playing a role with their symptoms.

Eosinophilic esophagitis and Allergies
Allergies are the result of a chain reaction that starts in the immune system. Your immune system controls how your body defends itself. For instance, if you have an allergy to tree nuts, the immune system identifies tree nuts as an invader or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction.

Food allergy is a major, yet complex, cause of eosinophilic esophagitis in children, and a probable factor in adult eosinophilic esophagitis.

Environmental allergies such as dust mites, animals, pollens and molds may also play a role.

Testing
Allergy skin tests are useful in determining which allergens are triggering your symptoms. With this test, a small amount of allergen is first placed on the skin. Then we prick the surface of the skin through the drop of the allergen extract. If a raised bump or small hive develops within 20 minutes, it indicates a possible allergy. If this does not develop, the test is negative.

In certain cases, such as severe eczema, an allergy skin test cannot be done and we may recommend a blood test. Another method for testing for food allergies is a challenge. This is done by feeding the food to find if it causes a reaction.

Food patch testing is in another type of allergy test that may be used in the evaluation of EE. This test is used to determine whether an individual has delayed reactions to a food. The patch test is done by placing a small amount of fresh food in an aluminum chamber. The food stays in contact with the skin for 48 hours, is removed and we reads the results at 48- 72 hours. Areas of the skin in contact with the food that have become inflamed indicate a delayed reaction to the food.

Treatment

Elimination Diet
Information about specific food allergies obtained from prick, blood and patch testing can be used to determine if specific food groups should be eliminated from your diet. For many people, this is the only treatment that is required to control eosinophilic esophagitis.

In some instances, all sources of protein must be removed from the diet. This approach is generally reserved for individuals with multiple food allergies, or who fail to respond to other forms of therapy

Medications
No medications are currently FDA approved for the treatment of eosinophilic esophagitis. New forms of therapy are under investigation and may provide significant relief in the future. In the meantime, we are using swallowed inhaled steroid from an asthma inhaler to treat EE.  Other medications are used but each patient is treated individually. After we evaluate each patient and perform appropriate testing, we will determine a treatment plan specific for them.

Please call our office at 212-305-2300 for further information.