Yes, allergies can cause esophagitis, specifically a condition called eosinophilic esophagitis (EoE).
Eosinophilic Esophagitis (EoE) Explained
Eosinophilic esophagitis is an allergic inflammatory condition affecting the esophagus. It occurs when a large number of eosinophils, a type of white blood cell, accumulate in the lining of the esophagus. This inflammation can damage the esophagus, leading to a variety of symptoms.
How Allergies Trigger EoE
EoE is often triggered by an allergic reaction to certain foods or, less commonly, airborne allergens. The immune system mistakenly identifies these substances as harmful and releases eosinophils to attack them. In EoE, this immune response occurs specifically in the esophagus. The result is inflammation, which can cause:
- Difficulty swallowing (dysphagia): The inflamed esophagus can narrow, making it difficult for food to pass through.
- Food impaction: Food can get stuck in the esophagus.
- Chest pain: The inflammation can cause discomfort in the chest.
- Heartburn: Although heartburn is commonly associated with acid reflux, it can also be a symptom of EoE.
- Abdominal pain: Eosinophilic esophagitis can cause abdominal pain.
Diagnosis and Treatment
Diagnosing EoE typically involves an upper endoscopy with biopsies. During this procedure, a doctor inserts a thin, flexible tube with a camera into the esophagus to examine its lining and collect tissue samples. The biopsies are then examined under a microscope to count the number of eosinophils present.
Treatment for EoE focuses on reducing inflammation and managing symptoms. Common approaches include:
- Dietary Modifications: An elimination diet, guided by an allergist or gastroenterologist, can help identify and remove trigger foods. This might involve initially removing common allergens (milk, soy, wheat, eggs, nuts, and seafood) and then gradually reintroducing them to see if symptoms return.
- Medications:
- Topical corticosteroids: These medications, such as swallowed fluticasone or budesonide, are applied directly to the esophagus to reduce inflammation.
- Proton pump inhibitors (PPIs): While not a direct treatment for the allergic component, PPIs can help reduce acid production, which can sometimes exacerbate EoE symptoms.
- Dupilumab: This biologic injection is approved by the FDA to treat eosinophilic esophagitis in adults and children 1 year and older. It works by blocking IL-4 and IL-13, two proteins that contribute to the inflammation of eosinophilic esophagitis.
- Esophageal dilation: In cases of severe esophageal narrowing (strictures), dilation may be necessary to widen the esophagus and improve swallowing.
