Eosinophilic Esophagitis (cont.)
Bhupinder Anand, MD
In this Article
What about elimination diets for treating eosinophilic esophagitis?
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The leading theory about the cause of eosinophilic esophagitis is that it represents allergy to some protein found in food. Evidence has accumulated in children that diets that eliminate the allergy-inducing food can result in reversal of the esophagitis and disappearance of the eosinophils. Similar evidence now is accumulating in adult patients. Doctors have used elimination diets to define what the allergy-inciting foods might be.
There are several ways in which elimination diets can be attempted. The first is to do skin and blood tests looking for specific foods that might be causing the allergy and then eliminating these foods from the diet. The second is to eliminate the major groups of food to which allergy is common, specifically milk protein, soy, peanut/tree nuts, eggs, wheat, and seafood. Finally, individuals may be placed on an elemental liquid diet (a diet of digested food that no longer contains proteins that can provoke allergy), and then different foods can be added to the diet until the allergy-inducing food is found. None of these elimination diets are easy for physicians to perform or for patients to follow, especially children, and each has its pros and cons. Nevertheless, if one or two foods can be found that are responsible for the allergy, a near-normal diet can be resumed, and the need for medications can be eliminated
What is the future of eosinophilic esophagitis?
Eosinophilic esophagitis in adults is a newly-recognized disease. Therefore, understanding of the cause(s), natural history, diagnosis and management is limited and will evolve over the coming years. Currently, the recommended treatments (for example, with oral fluticasone propionate) are based on a limited number of small studies. More studies involving larger numbers of patients followed for longer periods of time are necessary to determine the long-term efficacy and safety of treatment.
Montelukast (Singulair) is an oral leukotriene receptor antagonist that is used for treating asthma and seasonal allergic rhinitis (hay fever). Leukotrienes are a group of naturally occurring chemicals in the body that promote inflammation in asthma, seasonal allergic rhinitis, and other diseases involving allergy. They are formed by cells, released, and then bound to other cells that participate in inflammation. It is the binding to these other cells that stimulates the cells and promotes inflammation. Montelukast blocks the binding of some of these leukotrienes and has been used with success in treating a small number of patients with eosinophilic esophagitis. It improves symptoms but does not reduce teh numbers of eosinophils. More studies are needed.
Cromolyn is a synthetic compound that is used to prevent allergic reactions. Many of the symptoms and signs of allergic reactions are caused by chemicals, for example, histamine, that are released from mast cells, a type of cell that is found throughout the body as well as in the lungs, nose, and eyelids. Cromolyn works by preventing the release of these chemicals from the mast cells. Cromolyn is inhaled to prevent episodes of asthma due to allergy. It also is used as a nasal inhaler to treat seasonal allergic rhinitis (due to inflammation of the lining of the nose) and as an ophthalmic (eye) solution to treat allergic conjunctivitis (due to inflammation of the lining of the eyelids). More studies are needed to determine whether cromolyn is effective in treating eosinophilic esophagitis.
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