Eosinophils (pronounced ee-oh-sin-oh-fills), are a type of white blood cell. They are part of our immune system, and thought to be responsible for defending us from parasites. In some people, eosinophils build up in the gut or other parts of the body. This build-up is thought to be a reaction to allergens and other unknown triggers. It causes inflammation and can lead to permanent damage to the tissue.
The oesophagus is the muscular tube that connects the mouth to the stomach. Eosinophilic oesophagitis (EoE) happens when the eosinophils build up in the lining of the oesophagus. The cause is unknown, but most cases are seen in people with allergies such as food, allergic rhinitis (hay fever), and possibly asthma and/or eczema. It is rare, affecting around one in 2000 people (children and adults), but, like food and other allergies, appears to be increasing in prevalence.
When food is the cause of EoE, cow's milk (dairy products), wheat and egg are the major triggers. Soy, seafood and nuts can also be involved. Other people with EoE have found that symptoms appear only during springtime when they are exposed to pollens. In some cases, the triggers are not known.
Difficulty swallowing (known as dysphagia) or food getting stuck when you swallow (known as food impaction), are common signs. Children might be slow in eating and choke or gag. Some people might need to eat pureed foods, or drink water regularly to help food go down. Other symptoms include:
- Nausea, persistent vomiting and retching;
- Abdominal or chest pain;
- Reflux that does not respond to anti-acid medication;
- Failure to thrive (failure to put on or loss of weight) due to inadequate intake.
If left untreated, it can cause permanent damage to the oesophagus.
If EoE is suspected, the patient should be referred to a specialist. An endoscopy with biopsies is the only way to confirm EoE at present. A diagnosis cannot be based upon symptoms alone. The endoscopy is usually done by a gastroenterologist, and the patient is usually co-managed by gastroenterologists, allergy specialists and specialist dietitians. Diagnosis may confirm the patient has EoE but not necessarily what the triggers are.
In some cases, symptoms may resolve over time, but in most cases, EoE is a chronic condition. Medications are prescribed to treat symptoms and help reduce inflammation, while dietary management can help identify triggers. It is important these be done under specialist supervision.
Living with EoE
The initial diagnosis can be overwhelming for patients and their families. There is a lot to adjust to and learn. The challenges of living with EoE will also depend on the severity and complexity of their condition, which may take a while to understand. It may help to learn what you can from trusted sources and find support from those who understand.
ausEE Inc is a great resource to families and individuals affected by eosinophilic disorders. It is a national charity in Australia, and they are happy to assist Kiwi families. Check out their website, Facebook and resources: https://www.ausee.org/
See also: https://www.allergy.org.au/patients/food-other-adverse-reactions/eosinophilic-oesophagitis
Allergy Today, 30 October 2020