Eosinophilic oesophagitis (EoE), also known as allergic oesophagitis, is an allergic inflammatory condition of the oesophagus that involves eosinophils, a type of the white blood cell that are know to be involved in allergic reactions and inflammation. Symptoms include difficulty swallowing (dysphagia), food impaction, regurgitation (gastro-oesophageal reflux) and heatburn (dyspepsia).
These symptoms are thought to be an allergic reaction to ingested food. The diagnosis of EoE is typically made on the combination of symptoms and findings on diagnostic testing. The condition is not fully understood, but is know to affect young children, teenagers and adults, with more males being affected than females. Many people with EoE have other allergic or autoimmune disease such as asthma or coeliac disease. Food allergy does plays a role in the development of the condition, mediated by a non-IgE response.
The dietary treatment options consist of removal of known or suspected food triggers, with the most commonly implicated foods to be cow’s milk, egg, wheat and soya with fish and nuts being other possible triggers but to a lesser extent. Allergy testing, using skin prick tests or specific IgE blood tests, may be helpful in identifying triggers for some people and not in others. Working through exclusions of implicated foods one at a time may help to identify triggers. In some centres, the four food exclusion diet is used, but the diet is restrictive and hard to follow for teens.
Allergic oesophagitis is best managed by a multi-disciplinary team involving Paediatric Gastroenterologist, Allergist, Pathologist and Registered Dietitian.