Eosinophils, a type of white blood cell, are an important part of the immune system.  A high number of eosinophils in the blood are commonly seen in eosiniophilic esophagitis (EoE) and varying other conditions, such as parasite infection, food, drug allergy and asthma to name a few.  The esophagus is the tube that sends food from the mouth to the stomach.  While normally there are no eosinophils in the esophagus, in EoE large numbers of esosinophils are found in the inflamed tissue.

EoE is an allergic and inflammatory disease.  It affects from one to four of every 10,000 people in the United States, and may occur in certain families.  An estimated 50 percent of patients with EoE also have seasonal allergies, asthma, eczema or even food allergies.   Environmental allergies to allergens such as dust mites, animals, pollen and molds may also play a role in some patients with EoE, therefore, both genetic and environmental factors play a significant role in the development of the disease.

EoE can occur at any age and most commonly occurs in Caucasian males.  The symptoms of EoE vary with age.  Infants and toddlers may refuse food or fail to grow properly.  Young children, often have recurring abdominal pain, trouble swallowing, or vomiting.  Older children and adults most often have difficulty swallowing or suffer food stuck in the esophagus.  Proper diagnosis of EoE needs be confirmed by both an allergist and a gastroenterologist, each of whom will take a detailed clinical history.  Additionally, skin tests to food or even inhalant allergens will be ordered, as well as an upper endoscopy with biopsy to examine for eosinophils and inflammation of the esophagus.   Gastrointestinal reflux or other inflammatory conditions need to be excluded as well.

The relationship between food allergy and EoE is very complicated.  In some patients, a triggering food can cause a conventional and immediate IgE-mediated reaction or non-IgE mediated delayed reaction.  Allergies to these foods often cannot be easily proven by conventional allergy tests (skin tests or blood tests).  Occasionally, food patch testing, done in the research center is used to determine if the patient has delayed reactions to a food.  Eliminating major food allergens from diet including dairy, egg, wheat, peanut, tree nuts and fish have been shown to be very helpful in treating some patients with EoE.  Amino acid based formulas and dietary elimination are very effective therapies for children with EoE.  Consultation with a registered dietitian is necessary to insure adequacy of calories, protein and micronutrients.

Glucocorticosteroids are the most helpful medications for treating EoE by reducing eosinophils and inflammation.  Proton pump inhibitors, which decrease stomach acid and inflammation, may also be effective.  When indicated, dilation of stricture of esophagus provides relief of dysphagia.