When a person develops first one, and then additional, atopic conditions as they get older, this is referred to as the atopic march, or the allergic march. Though the march can begin at any time, it usually occurs in early childhood, and after an initial diagnosis of atopic dermatitis (AD). Typical progression involves the diagnosis of food allergies, allergic rhinitis, and/or asthma.1 Recent research indicates that another atopic condition may also factor in as a late manifestation of the allergic march—eosinophilic esophagitis (EoE).2
What is eosinophilic esophagitis (EoE)?
EoE is an allergic condition categorized by chronic inflammation of the esophagus—the tube that sends food from the mouth down to the stomach. A person with EoE has large numbers of white blood cells called eosinophils in the tissue of his or her esophagus, the increase in eosinophils causes inflammation in the esophagus which lead to difficulty swallowing, vomiting, or recurring abdominal pain.2
The symptoms of EoE tend to vary across age groups. Food refusal and poor growth are common with infants and very young toddlers with EoE. Recurring abdominal pain, trouble swallowing, or vomiting may also be present in school-aged children. Symptoms for teenagers and adults are primarily trouble swallowing, especially with dry, dense, or solid foods. In extreme cases, the esophagus can become so narrow that food gets stuck, leading to food impaction, which is a medical emergency.2
Most people with EoE have a history of other atopic disorders such as asthma, AD, or food allergies. Exposure to an allergen can trigger EoE symptoms.2
What causes EoE?
Though it is known that EoE is an atopic, or allergic, disorder, it is not known what specifically causes EoE. The presence of eosinophils that build up in the esophagus in EoE are thought to be due to a reaction to foods, other allergens, or acid reflux. Like other atopic conditions, environmental factors, or genetics, or both may be the root cause.3
Is EoE part of the atopic march?
EoE tends to appear along with other common atopic disorders. In fact, one study found that two-thirds of patients with EoE also had either asthma, allergic rhinitis, or AD.4 Another study followed the progression of atopic disease, including AD, food allergies, asthma and allergic rhinitis, or hay fever, and found that the presence of these conditions was associated with a diagnosis of EoE later on.5 These findings suggest that EoE is most likely a late development of the atopic march.4,5
How is EoE diagnosed?
Diagnosis of EoE involves an endoscopy and biopsy of the esophagus. Your doctor will be able to analyze tissue samples from the biopsy to determine if you have EoE. Biopsy results, combined with the presentation of symptoms, can lead to a diagnosis of EoE. Because of the atopic nature of EoE, you may be referred to an allergist for additional allergy testing.2
What can be done to treat EoE?
EoE is a chronic allergic condition for which there is currently no cure. Depending on the condition that triggers or worsens the symptoms of EoE, your doctor may advise certain dietary restrictions or environmental allergy prevention strategies and treatment to help alleviate or prevent the symptoms of EoE. Medications may be prescribed, such as corticosteroids to reduce inflammation, or proton pump prohibitors (PPIs) to control the amount of acid in the espophagus.5
Hill DA, Spergel JM. The atopic march. Ann Allergy Asthma Immunol. 2018; 120, 131-137. Available from: http://www.annallergy.org/article/S1081-1206(17)31258-9/pdf. Accessed 7/23/18.
Eosinophilis esophagitis (EoE). American Academy of Allergy, Asthma & Immunology. Available at https://www.aaaai.org/conditions-and-treatments/related-conditions/eosinophilic-esophagitis. Accessed 7/23/18.
Mayo Clinic. Eosinophilic esophagitis. Available at: https://www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/symptoms-causes/syc-20372197. Accessed 8/6/18.
Brown-Whitehorn TF, Spergel J. The link between allergies and eosinophilic esophagitis: implications for management strategies. Expert Rev Clin Immunol. 2010;6(1):101. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821054/. Accessed 8/6/18.
Hill DA, Grundmeier RW, Ramos M, Spergel JM. Eosinophilic esophagitis is a late manifestation of the allergic march. J of Allergy and Clinical Immunology. 2018 June. Abstract. Available at https://www.sciencedirect.com/science/article/pii/S2213219818303325.