An Allergist's Approach to Eosinophilic Esophagitis

Abstract

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.