Eosinophilic esophagitis: A new food allergy scenario? – Harvard Medical Letters

In the early 1990s, doctors began to describe a new condition affecting the patient's throat that is sensitive to allergies such as food allergies, asthma, and eczema, and those who have difficulty swallowing. Today, we call this condition eosinophilic esophagitis (EoE).

What is EoE?

EoE is an inflammation of the esophagus that causes various symptoms. Teenagers and adults often find it difficult to swallow, sometimes feeling food slowly leaving the throat and stomach. In some cases, the food is really tight (and they need to quickly remove looga). Some children and adults experience symptoms of pain and constipation rather than swallowing.

In most cases, EoE develops an allergic reaction to certain foods including wheat, milk, eggs, soy, nuts, and seafood. If not diagnosed properly and treated, EoE can lead to permanent scarring or irritation (itchy rash).

How is EoE identified?

When EoE is suspected, generally the first examination is an upper endoscopy, in which a flexible tube with a small camera and one copy is used for esophagus screening. # 39; endoscopy & # 39; often exhibits EoE symptoms, such as punctuation and tearing of straight lines or lines, as well as white spots or small patches.

Diagnosis is confirmed if ovarian cells show a marked increase in disease & # 39; eosinophils & # 39; Disease & # 39; Eosinophils & # 39; it is a rare type of immune system that plays a major role in allergic reactions including EoE and asthma.

How common is EoE?

EoE can occur in both men and women, regardless of age, but appears to be most common in men in their 30s and 40s. It is now estimated that EoE can affect up to one in every 2,000 adults in the United States, and evidence shows that the numbers are increasing. A recent review of nearly 30 studies in Europe and North America found that there was a growing trend in the number of new cases of EoE, especially since the early 2000s.

The increase in cases of EoE may be partly due to greater awareness of the condition and widespread use of endoscopy. But several studies have confirmed the true rise of the disease.

Why does EoE rise?

The exact cause of EoE growth is unknown, and it is particularly surprising that in many cases EoE results from well-tolerated food allergy to that extent.

There are several theories as to why EoE is increasing. Many of them are related to the idea that EoE, as well as other allergic and autoimmune diseases, appear to be associated with mild exposure to microbes and infections. Possible explanations explored include:

  • Hygiene hypothesis: are fewer and fewer pediatric illnesses similar to allergens?
  • Microbial dysbiosis: has Western diet and lifestyle changed our microbiome?
  • Environmental factors: changes in food production, genetic modification of crops, chemical additives, food processing, and pollutant roles?
  • Decrease in number H. pylori infection: it might not be popular in the stomach bacteria (due to normal wounds) to protect certain allergic diseases?
  • Frequent increase in gastrointestinal disorders (GERD): known as reflux & # 39; can break the itch and allow food allergies to trigger the immune system?
  • Increasing the use of acid control drugs: Does the use of & # 39; antacids & # 39;, especially in early life, alter esophageal microbes or otherwise alter the risk of food allergy later?

How is EoE treated?

Currently there are no treatments approved by the FDA for EoE. Most people are first treated with a & # 39; proton-pump inhibitor (PPI) & # 39; antacid, which resolves EoE in up to half of cases. If this does not work, moderate-dose steroids or identification and destruction of the specific food stimulants are attempted.

When steroids are used to treat EoE, these are generally in a liquid form that is swallowed, rather than inhaled as they would in asthma. Stretching strategies act in a small itchy environment and are slightly absorbed by the gastrointestinal tract. Although steroids for EoE are generally safe and effective, they do not lead to long-term treatment because the disease tends to return as long as the patient continues to eat foods that stimulate the immune response. .

Patients can also choose to identify their triggers and remove them from the diet, and this represents a more effective form of treatment. Unfortunately, current allergy testing cannot be predicted for foods that cause EoE. Dissociated foods generally need to be identified using the & # 39; s process of digesting. Sorghum and milk are two of the most common causes of EoE, and patients will often start by eliminating these two ingredients in about eight weeks. There, the symptoms are reviewed, and they will undergo repeated resection with biopsies to determine if the eosinophils disappear & # 39; in response to dietary changes.

Several treatments are underway. These include good forms of steroids and biological drugs that reduce the activity of eosinophils.


If you have trouble swallowing or are experiencing food stuck in your throat, especially if you have other allergies, discuss your symptoms with your doctor. Unknown or untreated EoE can lead to permanent damage to your throat.

For more information or to learn about EoE coping strategies, visit the American Society for Eosinophilic Disorders.