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It is well known that foods can cause a variety of G-I complaints through a variety of non-immunologic and immunologic reactions. Eosinophilic esophagitis (EE) is one such entity that has gained increased recognition by allergy doctors over the past decade.  Eosinophils are the classic “allergy” cell implicated in the pathogenesis of both asthma and allergic rhinitis.

EE patients have an abnormal accumulation of eosinophils in the esophagus, the main digestive tube leading to the stomach. EE can manifest in any number of ways depending on age of patient and severity of the eosinophilic accumulation.  Younger patients typically manifest failure to thrive/poor weight gain, and frequent “spitting up”. Older patients may manifest difficulty swallowing, food impaction, abdominal and/or chest pain.

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Dr. Gary Moss

IEE is an active area of research. In numerous studies, foods have been shown to be causative in EE. Thus far, it is believed that EE is the result of both Type 1 (immediate) and Type 4 (delayed) hypersensitivity to food.

While inhaled corticosteroids and perhaps other anti-inflammatory agents have been shown by allergy doctors to be effective, identification and elimination of the food trigger provides a more direct approach. This is accomplished by a variety of testing methods at an allergy and asthma clinic, i.e., serologic, prick and patch testing. This is 75%* effective. Elemental diets can be effective, but patient compliance is understandably poor. Most of these patients have classic allergic involvement, i.e., allergic rhinitis/sinusitis, asthma, etc., but it is not clear at this time if aero-allergens contribute to EE. The role of specific immunotherapy, anti IgE monoclonal therapy, etc., is not clear and pilot studies are underway which, hopefully, will add insight. Until that time, antigen avoidance remains a crucial part of the treatment of EE.

*Spergel J.A.C.I. 2007 (119) p.504
Ann. All. & Imm. 2005: (95) p.336

About The Author
Dr. Gary B. Moss received a BA in Biology from the University of Chicago and an MS in Human Physiology from Georgetown University. He graduated from the Medical College of Virginia, where he also completed his Internship and Residency in Internal Medicine. He served as a Fellow of Allergy and Immunology at Barnes-Jewish Hospital and Washington University at the St. Louis School of Medicine.

He is Board Certified in Internal Medicine and in Allergy and Immunology. Dr. Moss is on staff at Sentara Norfolk General Hospital, Sentara Leigh Memorial Hospital, Bon Secours De Paul Hospital, and Chesapeake General Hospital.

About Our Allergy & Asthma Clinic
For more than five decades the allergists and immunologist at Allergy & Asthma Specialists have been successfully treating adults and children in Virginia Beach, Norfolk, Chesapeake, Portsmouth, and throughout Hampton Roads, where the climate is conducive to allergies and asthma problems. Our allergy doctors treat allergic diseases such as Asthma, Hives, Allergic Rhinitis (eyes, ears, nose), Hay Fever, Food Allergies, Eczema, and more.