Eosinophilic Esophagitis

Eosinophilic Esophagitis is an allergic inflammatory disease characterized by elevated eosinophils in the esophagus. It decreases the ability of the esophagus to stretch and accommodate swallowed food. As a result, solid foods will have difficulty passing through the esophagus. The major symptom among adults is difficulty swallowing solid food (dysphagia). Less common symptoms include heartburn and chest pain. Among children, the most common symptoms are abdominal pain, nausea, vomiting, and failure to thrive. The incidence of EE is on the rise in the U. S. Eosinophilic Esophagitis affects both children and adults. Men are more commonly affected than women.

The diagnosis of Eosinophilic Esophagitis is suspected whenever dysphagia for solid food occurs and endoscopy is performed to establish the diagnosis with a biopsy of the esophagus showing increase number of eosinophils in the esophagus. Two most common causes for EE are acid reflux and food allergy.

Once the diagnosis of EE is confirmed, allergy testing is typically requested. In many situations, avoiding food that triggers the increase eosinophils migration to the esophagus will be effective treatment. The reactions to foods are not always ‘immediate hypersensitivity’ (IgE-mediated). This means that a food can be consumed with no obvious reaction to it, but over a period of days to weeks the eosinophils triggered by the food will cause inflammation and injury to the esophagus. For this reason, skin testing for immediate allergy reaction is supplemented by patch testing (to look for delayed reactions).

Skin prick testing is for IgE- mediated reactions (immediate hypersensitivity). In skin prick test a tiny amount of allergen is lightly pricked into the skin with a plastic applicator. This test is performed on the back or sometimes on the arms. A ‘wheal’ (bump) and flare (redness) indicates a positive test.

Patch testing; small amount of tiny quantities of foods in individual round aluminum chambers are applied to the upper back. They are kept in place with special hypoallergenic adhesive tape. The patches stay in place undisturbed for 48 to 72 hours. The testing generally takes about 1/2 hour to complete but the visit will be for an hour.