What is Eosinophilic Esophagitis (EE)?

Eosinophilic esophagitis (EE) is a disease characterized by swelling of the esophagus (the part of the body connecting the throat and the stomach) caused by an allergic white blood cell, the eosinophil. Symptoms of EE can range from severe heartburn, difficulty swallowing, food impaction in the esophagus, nausea, vomiting and weight loss. There appears to be some age-related differences in symptoms, with younger children having more symptoms of weight loss, and older children and adults having food impaction and difficulty swallowing.

It is not exactly clear what causes EE, although this disease may be related to other allergic diseases, particularly asthma. People with EE frequently have a personal or family history of other allergic diseases such as hay fever, food allergy and asthma. Recently, there have been studies showing an association between food and environmental allergies and EE.

What Allergic Triggers Commonly Cause EE?

Various studies have shown that patients with EE have positive allergy tests to various foods, and that avoidance of these foods led to the resolution of EE symptoms. Foods reported to be the cause of EE have included milk, eggs, peanuts, shellfish, peas, beef, chicken, fish, rye, corn, soy, potatoes, oats, tomatoes and wheat. Of these, the most common food triggers are milk, egg, wheat, rye and beef.

Environmental allergens, such as pollens, molds, cat, dog and dust mite allergens may also be involved in the development of EE.

How is EE Diagnosed?

The diagnosis of EE is generally made by performing a biopsy of the esophagus, with evidence of eosinophils infiltrating the esophageal tissue. A biopsy is performed via endoscopy (a camera inserted into the esophagus), usually by a gastroenterologist. There are many other diseases that can cause eosinophils in the tissue of the esophagus, including gastroesopheal reflux disease (GERD), parasitic infections, fungal infections, inflammatory bowel disease, certain cancers, recurrent vomiting, and others. These diseases need to be ruled out before EE can be diagnosed.

Once EE is diagnosed, an allergist will typically perform extensive allergy testing, including looking for food allergies and environmental allergies, such as those listed above.

How is EE Treated?

A trial of avoidance of the foods to which the person has positive allergy tests is the initial form of treatment for EE. If a person has numerous positive allergy tests, however, it may be important to change to a diet consisting only of an elemental formula (proteins broken down into the most basic building blocks, called amino acids).

Corticosteroids are frequently used to treat EE when avoidance of allergic triggers unsuccessfully relieves symptoms. Steroids may be used as pills, such as prednisone, or as a topical therapy, such as using inhaled steroids (Flovent, for example) typically used for asthma, except that the medication is swallowed, not inhaled. This results in the delivery of the medication directly to the esophagus. Typically, medications for GERD are also given to patients with EE.