EoE linked with food allergy
Q: We recently found out my husband has EoE – allergic to barley, legumes, nuts and mustard. He is on an oral steroid, something for heartburn and something for some itching he has once in a while. It’s the steroid we are trying to get away from. It is VERY expensive and well, steroids have some scary side effects. We are hoping for something holistic. He is in his early 50s and in general good health. He does have a rapid heart rate that no one has been able to pin down.
Do you have any suggestions or thoughts on this matter? Thank you for your help.
A: EoE is an acronym for eosinophilic esophagitis, an inflammatory condition that affects the muscular tubing from the pharynx to the stomach. An individual with EoE will have a larger than normal number of eosinophils (which must be 15 or more), and are a type of white blood cell, detected in the esophagus. To slightly complicate things, diseases and disorders other than EoE can cause these eosinophils and include inflammatory bowel disease and gastroesophageal reflux disease (GERD).
Research suggests the primary cause to be an airborne sensitivity or allergen to specific proteins found in foods. Individuals with EoE commonly have a history of other allergic disorders such as asthma, rhinitis and eczema. EoE is rather newly recognized but is increasing in prevalence as medical knowledge of the disorder increases. There are genetic tendencies recorded.
Symptoms include chest and abdominal pain, reflux that fails to respond to acid-blocking medication, dysphagia (difficulties swallowing) and vomiting that often occurs while a person it sitting at the table attempting to ingest a meal. Children so diagnosed will likely experience weight loss, decreased-to-minimal appetite and slow growth.
Previously, adults who presented with solid food dysphagia were examined for fibrotic stricture obstructions. If none were found, the patient probably didn’t receive any treatment at all. Fortunately today because of increasing knowledge of the disorder, most patients with solid food dysphagia undergo esophageal biopsy. Endoscopy (the use of a lighted device for examining organs and body cavities) may be performed by a health care professional. With appropriate testing, more than 75% of those EoE cases will also reveal abnormal mucosa to include linear furrows, white plaque and a ringed esophagus. Clinical symptoms, the exclusion of gastroesophageal reflux disease (GERD), the number of eosinophils present and tissue inflammation will be confirmatory.
There are no FDA-approved medications at this time for EoE; however numerous articles advocate swallowing steroids approved for inhalation. Unfortunately, inhaled steroids are first line medical treatment at this writing. Other medications include protein pump inhibitors. Maintenance therapy is extremely important with EoE because of the potential for recurrence. Food allergies that act as triggers for EoE can be identified by allergists and withdrawn from a patient’s diet, while primary care physicians will likely prescribe steroids, a nebulizer or asthma inhaler. I am unaware of an alternative therapy for treatment but your husband’s physician may be willing to experiment with a different, less expensive medication that doesn’t have the sometimes devastating side effects of long-term steroid therapy.
Readers who would like related information can order Dr. Gott’s Health Report “Allergies” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Dr. Gott’s Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.