Typically allergies affect your upper respiratory tract with itchy watery eyes, sneezing, and a runny nose. This can contribute to lower airway issues such as asthma and cough. Secondly, they can lead to dermatologic manifestations such as eczema, dermatitis, and urticaria. Eosinophilic esophagitis seems to be a manifestation of allergic disease on the digestive system. It can lead to various inflammatory symptoms and even difficulty swallowing due to strictures in the esophagus.
Until recently, esophageal eosinophilia was primarily attributed to acid reflux esophagitis. Allergic patients who developed swallowing problems and intestinal symptoms underwent endosocopy and white blood cells called eosinophils were found infiltrating the mucosa. Even though we associate eosinophils with allergy, we did not make that clinical connection until recently.
In the last five years, eosinophilic esophagitis—also known as allergic esophagitis, primary eosinophilic esophagitis, and idiopathic eosinophilic esophagitis—has emerged as an important independent allergic condition found to occur in children and in adults.
Comprehensive allergy testing and immunotherapy for inhalant allergies have proven effective. That is, aggressively treating inhalant allergies with immunotherapy (allergy shots or drops) helps in treating eosinophilic esophagitis. Immunotherapy for food allergies is still being studied.
Singulair, carafate, and chromolyn may be helpful. Xolair and IL-5 inhibitor are still experimental. Food allergy testing is always completed and elimination diets are considered. A trial of an elemental amino acid diet may be entertained, but is rarely practical.
Eosinophilic Esophagitis (EoE) Treatment Options:
1) Swallowed Fluticasone. You can also use Budesonide mixed with Splenda instead of Fluticasone if you like.
2) Targeted dietary avoidance based on results of skin prick and patch testing to foods. If not successful, I then try empiric elimination diet. Rarely have I needed to resort to elemental diet (in a case of a child with severe oral aversion).
3) Aggressive management of aeroallergen hypersensitivity (can also trigger GI eosinophilia), that is Avoidance, Medications, and Allergy Shots. Singulair is helpful in about one half of the patients.
4) Proton Pump inhibitor (often 2 times per day) These patients generally get scoped quite frequently to monitor their progress. Dysphagia must sometimes be treated by esophageal dilatation.