How to Manage Eosinophilic Esophagitis During Allergy Season

If you have eosinophilic esophagitis (EoE), you may also have allergies, in the form of allergic rhinitis or food allergies. That’s not a coincidence. The two (or even three) conditions often coexist.

“Most people [with EoE] have a lot of allergies … or they’ve dealt with them in the past,” says Ashkan Farhadi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center in Fountain Valley, California. Moreover, allergies may exacerbate the symptoms of EoE.

Getting to the bottom of allergies and understanding how they affect your esophagus can help you sidestep more serious complications.

Experts suspect genetic or environmental factors play a role in the development of EoE. What is known, though, is that EoE can be caused by antigens (i.e., toxins) that trigger an overaction in the immune system. It’s common for these antigens to be food related, because the mucous membrane in the esophagus is so frequently exposed to food.

Common food allergen triggers for EoE include dairy, eggs, nuts, seafood, soy, and wheat, says Mary Ann Huang, MD, a hepatologist and gastroenterologist with HCA HealthONE Presbyterian St. Luke’s in Denver. Often, people are aware of allergens that make symptoms worse for them, she says. “In speaking to patients, they may point to a specific food that causes issues with dysphagia, or difficulty swallowing.”

There are medical and lifestyle tweaks that can help manage both allergies and EoE symptoms.

First off, you’ll want to determine your trigger foods and then avoid them. “Elimination diets are often a first-line treatment,” says Dr. Huang. You’ll likely start by cutting out common allergens — eggs, nuts, soy — from your diet. Then, your gastroenterologist will do a biopsy of your esophagus to see if the inflammation is under control. If so, you may slowly reintroduce foods. Once you know your triggers, avoiding them entirely is best.

It’s also important to take steps to deal with environmental allergens if you have them, though this may have less of a direct impact on esophageal symptoms. Seeing an allergist to narrow in on the exact allergies you have is a good first step. Talk to them about whether you should get an allergy shot or take an antihistamine regularly.

If seasonal allergies tend to worsen EoE for you, check the pollen count in your area, and avoid the outdoors on days when it’s high. If possible, try to keep the windows closed — pollen can come in through an open window or door — and shower at night to remove pollen from your body before bed, so you’re not inhaling it all night.

Finally, talk to your doctor about the symptoms you’re having, to determine if the medications you currently take are adequate or if you need to make adjustments. EoE and its related conditions are quite varied and can turn critical quickly, so getting a correct diagnosis and treatment plan in place are key.

• EoE and allergies often go hand in hand. Many people with EoE also have food or seasonal allergies, which can make esophageal symptoms worse.
• Triggers can vary, from foods to seasonal allergies. Common food allergens, such as dairy, eggs, soy, and wheat, can flare symptoms, but pollen and other airborne allergens may also play a role, especially during high-allergy seasons.
• Managing allergies can help protect your esophagus. Identify trigger foods, address environmental allergies, and work with your doctor on the right treatment plan to help keep inflammation under control and prevent complications.