From eating peanut butter at an earlier age to avoiding dish washing, the topic of food allergy development has been hitting the national spotlight recently. And for a good reason — food allergies are a problem for more than 50 million people in the U.S., including 6 million children, according to the non-profit group, Food Allergy Research & Education. Another disease associated with food allergy is beginning to take center stage. It’s called eosinophilic esophagitis (EoE), and while we’re learning more about it everyday, the incidence continues to grow.
Eosinophilic Esophagitis Symptoms & Testing
Although we’re not exactly sure what triggers EoE, we know that immune cells called eosinophils cause the esophagus to become inflamed. Eosinophils are a type of white blood cell that isn’t normally present in the esophagus, but can help fight off certain types of infections. When large amounts of these cells collect in the esophagus, it can cause symptoms like inflammation, scarring and narrowing of the esophagus.
We’ve seen that most cases of EoE are connected to food allergies, so eosinophilic esophagitis treatment and management includes tests to identify the allergen, elimination of certain foods from the diet, and medications. Often the problem is among the eight foods that cause about 90 percent of all food allergies in the U.S.: peanuts, tree nuts, cow’s milk, eggs, wheat, soy, fish and shellfish. However, sometimes symptoms are seasonal and related to pollen that easily gets inhaled and swallowed.
Unfortunately, EoE may be difficult to diagnose because, in most cases, the reaction and swelling is a gradual process. In fact, as an allergist at The Ohio State University Wexner Medical Center, I’ve seen that EoE can affect people who aren’t aware they have allergies in the first place. This means that patients might be eating foods that cause eosinophils to build up in their esophagus without knowing it. Over time, they can develop enough inflammation that they start having symptoms, including trouble swallowing and abdominal pain during or after meals.
Depending on age, symptoms can vary. Children with EoE can have trouble leading a normal life, often complaining of stomach pain or refusing to eat, vomiting frequently or having difficulty meeting growth milestones. Teens and adults may have difficulty swallowing, sometimes to the point that food gets stuck in the esophagus, forcing them to go to the emergency department for removal. They can also experience chest pain or persistent heartburn that isn’t relieved by medication.
Eosinophilic Esophagitis Treatment & Outlook
To treat EoE, we try to identify and eliminate the allergen. We also prescribe steroids to help coat the throat and reduce inflammation. If these treatments don’t work as well as we’d like, we might suggest dilation to help improve swallowing.
The tendency to develop most allergies is often hereditary. However, just because a parent has an allergy, it doesn’t necessarily mean their kids will be allergic, too. If you or your child is experiencing any of these symptoms, it’s important to see an allergist for evaluation.
A decade ago, there were only a handful of documented cases of EoE. Today, it could affect one in every 2,000 Americans. It’s likely this number could be greater, as it often goes undiagnosed. As the incidence of this condition grows, it’s crucial to close the knowledge gap in the medical community. At Ohio State University’s Wexner Medical Center, our researchers are working to learn more about eosinophils and how they affect allergies. We’re also partnering with Nationwide Children’s Hospital to identify the most common triggers associated with the disease.
Bio: Dr. Princess Ogbogu is the director of Allergy and Immunology at The Ohio State University Wexner Medical Center. She received her MD from Northeastern Ohio Universities College of Medicine in 2000 and completed her fellowship in Allergy/Immunology at the National Institutes of Health. She is certified by the American Board of Internal Medicine and the American Board of Allergy & Immunology.