An Allergist's Approach to Eosinophilic Esophagitis


  • Arun Dhir, MD Division of Allergy and Immunology, University of British Columbia
  • Edmond S. Chan, MD, FRCPC, FCSACI, FAAAAI Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children’s Hospital



Eosinophilic esophagitis (EoE) is a chronic, inflammatory disease of the esophagus that produces a range of symptoms in both adults and children, from acid reflux to food bolus impaction. The diagnosis is confirmed by endoscopic biopsies showing 15 or more eosinophils per high-power field. The pathophysiology of EoE is believed to be either immune-mediated or antigen-mediated, ultimately resulting in a T helper 2 (T H2) immune response, eosinophilic inflammation, barrier dysfunction, and tissue remodelling.

Since its recognition, EoE has been fundamentally linked to atopy, with early case reports drawing attention to this relationship. Patients with EoE tend to be highly atopic, demonstrating a higher incidence of allergic rhinitis, asthma and atopic dermatitis compared to healthy controls. There is also a high prevalence of IgE-mediated food allergies among these patients. A U.S.-based cross-sectional study reported that 32.4% of children and 37.3% of adults with EoE had an IgE-mediated food allergy to at least one food. More recent research has shown that 87% of a cohort of 92 EoE patients had comorbid atopic conditions. A review of 1,218 patients with EoE found that these patients have a 67-fold increased risk of anaphylaxis compared to that of the general population. With this in mind, allergists play a key role in controlling esophageal inflammation and addressing atopic comorbidities.

Author Biographies

Arun Dhir, MD, Division of Allergy and Immunology, University of British Columbia

Dr. Arun Dhir is an Adult Allergy and Clinical Immunology fellow in Vancouver, British Columbia, where he is undergoing training. He received his medical degree and completed his core Internal Medicine residency at the University of British Columbia. Arun has previously published and presented his work on inborn errors of immunity and drug allergy, and he is currently working on ongoing projects related to hereditary angioedema and perioperative anaphylaxis. Arun aspires to become a clinician-scientist in the future.

Edmond S. Chan, MD, FRCPC, FCSACI, FAAAAI, Division of Allergy, Department of Pediatrics, University of British Columbia, BC Children’s Hospital

Dr. Edmond S. Chan is a Pediatric Allergist at the BC Children’s Hospital (BCCH) Allergy Clinic in Vancouver, BC, Canada. He is a University of British Columbia (UBC) Clinical Professor, Clinical Investigator (BCCH Research Institute), and Head of the UBC Division of Allergy at BCCH, where he leads a dedicated food allergy research program. His primary interest is food allergy, and his secondary interest is eosinophilic esophagitis. He has 182 peer-reviewed publications, and is a co-author of several national/international guidelines on food allergy (including the first Canadian guidelines on food oral immunotherapy). He is Vice-President of the Canadian Society of Allergy & Clinical Immunology. He is on the Executive of the Canadian Paediatric Society’s Allergy Section, Food Allergy Canada’s healthcare advisory board, and the steering committee for Canada’s National Food Allergy Action Plan.


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How to Cite

Dhir A, Chan ES. An Allergist’s Approach to Eosinophilic Esophagitis. Can Allergy Immunol Today [Internet]. 2023 Aug. 31 [cited 2024 Jun. 14];3(2):5–10. Available from: