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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 Koenig received a BS in Biological Science from Southern
Methodist University in Dallas, Texas. He graduated from the Medical
College of Wisconsin. He completed an Internship and Residency in
Internal Medicine at Northwestern University in Evanston, Illinois.
Prior to Fellowship, Dr. Koenig worked as a Hospitalist in Waukesha,
Wisconsin. He served as a Fellow of Allergy and Immunology at Virginia
Commonwealth University in Richmond, Virginia. He is Board Certified
in Internal Medicine and Allergy and Immunology.
He is a member of several academic honorary societies, including Phi
Beta Kappa and Alpha Omega Alpha. He presented abstracts at several
recent American Academy of Allergy, Asthma and Immunology (AAAAI)
meetings. Dr. Koenig is on staff at Sentara Norfolk General Hospital,
Sentara Leigh Memorial Hospital, Bon Secours De Paul Hospital, and
Chesapeake General Hospital.
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