Eosinophilic Esophagitis
Eosinophilic Esophagitis is a condition where eosinophils (a type of white blood cell) infiltrate the esophagus. Eosinophils were originally a part of the immune system that would fight parasitic infections. However, in westernized society parasitic infections are uncommon. Over time, eosinophils have been recruited to fight allergens. In people with allergies in general, their immune system recognizes common proteins such as bermuda grass pollen, cat dander, peanut protein and attacks that protein as if it is a foreign organism. Eosinophils are recruited to help attack the protein, creating an inflammatory response and allergies. In EE, eosinophils infiltrate the esophagus and in Eosinophilic Gastrointestinal Disease (EGID) they infiltrate the esophagus, stomach and intestines. EGID is a more severe form of Eosinophilic GI disorders.
EE and EGID were first described in the late 1970’s. Since that time, the diagnosis has been increasing in frequency. Originally it was thought to occur about 1/100,000. However, the most recent studies show a prevalence of 4/10,000 children and 1/10,000 in adults. While we don’t have exact numbers in Arizona, allergists and pediatric gastroenterologists agree that the diagnosis is increasing in frequency. The cause of the condition is thought to be predominately food allergy. The food allergy is not like the classic allergy where a child eats a peanut and within minutes has swelling, hives, or shortness of breath. Rather, the reactions can be nausea, vomiting, diarrhea and can occur days later. Animal studies show that pollens can also cause the condition. One thing that we are seeing in Arizona is children with no food allergy by skin tests, but, massive reactions to pollen grains. Arizona may be unique in that the pollinating seasons are prolonged and it is actually the swallowing of pollen grains and not food proteins that is causing the reaction. Children can present in the first few years of life with poor weight gain and growth, nausea/vomiting, and difficulty swallowing. Adults present mainly with food impaction and difficulty swallowing.
People with EE and EGID usually have other additional allergic conditions like asthma, nasal allergies, food anaphylaxis and eczema. The disease is diagnosed by biopsy performed by a gastroenterologist. Allergies are identified by skin scratch tests and patch tests. Once foods allergens are identified treatment is through food avoidance, nutritional supplementation with elemental formulas and some additional medications. Elemental formulas are very expensive ($50.00/canister). The Arizona Legislature passed HB 2364 which states that insurances must pay 75% of elemental formulas up to $20,000.00 per year. Food modification can be a very difficult part of management. Some young children have such difficult problems with eating they need to have a tube put in their stomach and the formula is put in the tube. They then go to a clinic where they are taught how to eat. If children are not treated, they can have poor growth, esophageal strictures and tears. Currently, there is no cure for the disease. Medical treatment which has been proven to be effective involves swallowing an inhaled steroid called Flovent or Pulmicort on a daily basis. In addition, there are ongoing studies with drugs that block the molecule that attracts eosinophils. The goals of management are identifying allergens, expanding the diet, normal growth, and living as normal a life as possible. You should discuss all options with your doctor as you develop a plan to manage the EE. In addition, if you would like additional information go to www.apfed.org.
