Eosinophilic Esophagitis

It is well known that foods can cause a variety of G-I complaints through a variety of non-immunologic and immunologic reactions.  Eosinophilic esophagitis (EE) is one such entity that has gained increased recognition over the past decade.  Eosinophils are the classic "allergy" cell implicated in the pathogenesis of both asthma and allergic rhinitis.  EE patients have an abnormal accumulation of eosinophils in the esophagus, the main digestive tube leading to the stomach.  EE can manifest in any number of ways depending on age of patient and severity of the eosinophilic accumulation.  Younger patients typically manifest failure to thrive/poor weight gain, and frequent "spitting up".  Older patients may manifest difficulty swallowing, food impaction, abdominal and/or chest pain.

EE is an active area of research.  In numerous studies, foods have been shown to be causative in EE.  Thus far, it is believed that EE is the result of both Type 1 (immediate) and Type 4 (delayed) hypersensitivity to food.

While inhaled corticosteroids and perhaps other anti-inflammatory agents have been shown to be effective, identification and elimination of the food trigger provides a more direct approach.  This is accomplished by a variety of testing methods, ie., serologic, prick and patch testing.  This is 75%* effective.  Elemental diets can be effective, but patient compliance is understandably poor.  Most of these patients have classic allergic involvement, ie., allergic rhinitis/sinusitis, asthma, etc., but it is not clear at this time if aero-allergens contribute to EE.  The role of specific immunotherapy, anti IgE monoclonal therapy, etc., is not clear and pilot studies are underway which, hopefully, will add insight.  Until that time, antigen avoidance remains a crucial part of the treatment of EE.

The physicians and staff of Allergy & Asthma Specialists, Ltd. would be pleased to assist you in the care of these patients.

*Spergel J.A.C.I. 2007 (119) p.504

Ann. All. & Imm. 2005: (95) p.336

About the Author

Dr. Craig S. Koenig

www.allergydocs.net