Food allergy and eosinophilic esophagitis

Although the cause of eosinophilic esophagitis is unknown, allergic responses including food allergies have been implicated. An article recently published in the Cleveland Clinic Journal of Medicine reviews both conditions, focusing on how to detect and manage them.

Eosinophilic esophagitis has been recognised with increasing frequency in both children and adults over the past years. Symptoms can include difficulty feeding, failure to thrive, vomiting, epigastric or chest pain, dysphagia, and food impaction.

More than 50% of patients with eosinophilic esophagitis also have an atopic condition (eg, atopic dermatitis, allergic rhinitis, asthma), as well as positive results on skin-prick testing or measurement of antigen-specific IgE in the serum. Since the symptoms of eosinophilic esophagitis improve for most patients following either dietary restriction or elemental diets, food sensitisation appears to play a considerable role. However, few studies of the link between food allergy and eosinophilic esophagitis have been done in adults.

Identifying potential food triggers of eosinophilic esophagitis is difficult, although targeting specific food allergens to eliminate from the diet is likely to be more desirable than adhering to a very limited or elemental diet. In vitro food allergy testing to identify such triggers is not recommended due to a lack of positive or negative predictive values for food-specific IgE level testing in eosinophilic esophagitis. Furthermore, the absence of IgE does not eliminate a food as a potential trigger, since non-IgE mechanisms may play a role.

Because most patients with eosinophilic esophagitis have a strong history of atopic disease and respond to allergen-free diets, a complete evaluation by an allergist or immunology specialist is recommended.

Reference: Hong & Vogel. 2010. Cleveland Clinic Journal of Medicine. Vol. 77(1). Doi:10.3949/ccjm.77a.09018

This paper is currently available for free download from www.ccjm.org/content/77/1/51.full