My child was diagnosed with eosinophilic esophagitis (EoE), but his/her allergy tests were all negative. What does that mean?
This is one of the more frustrating situations encountered by families and physicians. About 25% of those with confirmed eosinophilic esophagitis (EoE) diagnosis do not test positive to foods. This does not necessarily mean that there is not an issue with a food(s). Allergy testing is not perfect. We have found that many of the children who tested negative to food(s) still respond when certain foods were removed from their diet. Figuring this out often takes patience. Medication therapy is one of the first approaches in cases like this; however, dietary changes can still be used. As always, you need to consult with your medical team to work through this. Treatment for eosinophilic disorders is not a "one glove fits all" approach.
Is it possible that eosinophilic esophagitis (EoE) is related to asthma? I have come to think that my child’s EoE is more environmental than food allergy.
Environmental allergens, such as aeroallergens, may indeed be a factor in eosinophilic disorders. In our experimental mouse models, intranasal administration of allergens can induce eosinophilic esophagitis (EoE). Additionally, some of our prior investigations have shown that indoor insect allergens can induce EoE in mice (Rayapudi et al. J Leukoc Biol. 2010). Thus, the oral/gastrointestinal exposure of an individual to food allergens may not be the only route / allergens to consider.
Can eosinophilic esophagitis (EoE) be seasonal?
Eosinophilic esophagitis (EoE) does have seasonal variation in some patients, typically with worse symptoms in the spring and summer.
Is IgG4 delayed sensitivity food testing helpful for patients with eosinophilic esophagitis (EoE)?
There is currently no proven value in IgG4 measurements in EoE, although this is an active area of research.
Is eosinophilic esophagitis (EoE) an autoimmune condition?
There is no evidence that EoE is an autoimmune condition.
Can I have your opinion on whether oral immunotherapy (OIT) may cause eosinophilic esophagitis (EoE)?
One of the possible side effects of oral immunotherapy (OIT) is the development of an eosinophilic gastrointestinal disorder (EGID), such as eosinophilic esophagitis (EoE). This highlights the intimate connections between allergic responses that cause anaphylaxis and those involved in EGIDs. When anaphylaxis is blocked with OIT, the immune system can continue to be allergic but manifest this continued allergy via a different response (e.g., an EGID). Indeed, patients with EGID generally have IgE against specific foods but do not have concurrent anaphylaxis, further highlighting the connection. Research concerning both disorders provides novel insight on each that may not have become apparent from researching these disorders individually, emphasizing why we strongly advocate for broad research inquiry rather than a strictly focused approach and why we aim to encourage food allergy research organizations/foundations to support EGID research. To more specifically answer your question, we do not have a formal recommendation about OIT but wish to point out that most patients on OIT have not been reported to develop EGID but that EoE is a current contraindication to OIT.
Why do we use Splenda with the slurry?
Splenda is used because it is thought to be inert, tasty and generally a safe mixture for individuals with food allergies or eosinophilic disorders. Additionally, mixing the liquid medication with Splenda provides the viscosity, or thickness, needed for the solution to coat the esophagus. A thinner solution may "rush" past the esophagus on its descent through the gastrointestinal tract.
Do you notice a difference in oral thrush infections with kids that use Splenda versus honey with their swallowed Pulmicort? Would the honey increase the risk of getting thrush because of the sugar?
It is unknown whether thrush would be worsened by the use of honey; however, there could be a concern regarding the use of honey simply as an added food agent.
Where can I find information about the long - term use of Flovent for the purpose of treating eosinophilic esophagitis (EoE)?
Inhaled Flovent has been used for long-term treatment of asthma in children. It is generally considered safe, although it can have effects on the rate of stature growth. The long-term effects of swallowing topical steroids for eosinophilic esophagitis (EoE) is not known, but it is generally thought to be even safer than taking the medicine for asthma as the swallowed form is generally not absorbed and the amount absorbed is degraded by the liver.
My child has eosinophilic esophagitis (EoE) and his/her doctor believes that it is aeroallergen-induced EoE. My child also has asthma. Could his/her asthma be a result of eosinophils in his airways? If so, is narrowing of airways as he grows older a concern?
Asthma is an allergic disease of the airways associated with eosinophilic lung inflammation, and it is generally believed that eosinophils are causing part of the lung problems and symptoms in this disease. In fact, the first class of new asthma medicines in over a decade were approved in late 2015 and early 2016, and the two drugs (Nucala and Cinqair) work by blocking eosinophils.
I know someone who had a nasal smear done because of repeated sinus infections. They found a high number of eosinophils, and when they repeated the smear while she was doing a dairy trial, the eosinophils increased. How are nasal eosinophils related to EoE?
Nasal eosinophils are not directly related to eosinophilic esophagitis (EoE); however, EoE is associated with allergic disorders, including upper respiratory allergies such as allergic rhinitis and nasal polyps. Both allergic rhinitis and nasal polyps are associated with nasal eosinophilia.
With so many organizations and people doing fundraisers, can you tell me how much money it will actually take for research to find a cure for eosinophilic esophagitis (EoE)?
We wish that we had that answer. We wish that we could accurately predict what the cure will be, how long it will take to find, and how much money it would take to do so. Unfortunately, the name of the process, "research", is very fitting in that we search over and over again ("re"). Research is the process of learning, discovery, and testing. We make headway with our hypotheses, learning from all research done, even (or perhaps "especially") that which overturns our theories on what may be happening. Every day we hope that one of our "Ah-ha!" moments will become the cure for eosinophilic gastrointestinal disorders (EGIDs). We can say with confidence that our research is already greatly influencing the way people think and treat EGIDs around the world.
