Eosinophilic Esophagitis
Eosinophilic esophagitis is a disease where eosinophils or white blood cells target cells which stain red and are target cell of allergy. These cells line the esophageal lining and prevent swallowing thick foods such as steak, chicken or oatmeal. Over time, these foods cause scar tissue and trouble swallowing. Patients sometimes need to have tubes inserted to inflate the tube in order to decrease scar tissue. These patients had allergies as a child and may have had atopic dermatitis, allergic rhinitis or asthma. The patients with atopic dermatitis usually had sensitivity to eggs, wheat, milk, and to a lesser extent soy, shrimp, shellfish and fresh water fish.
When eosinophilic esophagitis is manifest, we usually have the patient avoid eggs, wheat, milk and in some cases soy and fish. Diets can be used for 4 weeks to then see if symptoms resolve. Diagnosis is made by gastroscopy and results of biopsy that shows greater than 50 eosoinophils per high power field. The diagnosis is performed when inflammation includes both the proximal and eosinophilic esophagitis.
A new biologic has been approved by the FDA, Dupixent (dupilimab). This medication inhibits development of esoinophilic esophagitis and interleukin-4 and il-13. These interleukins help the B cell convert to eosinophils and develop the disease. The approved dose is one shot of 300 mg per week. Studies demonstrate improvement of the underlying EoE. However, 95 percent of patients will develop eosinophilic esophagitis if it is not treated. This medication removes the symptoms of not swalloing the food and other symptoms.
If you need to book an appointment for your allergies or asthma, you can book your appointment online, or call 212-247-7447.