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“Timely and appropriate treatment of one allergy can keep other allergies at bay”
New Delhi, June 26, 2018:
Children with known skin, food, and respiratory allergies should be screened for an emerging, chronic food allergy called eosinophilic esophagitis (EoE), a painful inflammation of the esophagus, the food tube between the mouth and stomach. Allergies in children may have a common underlying biological cause and imply that if an earlier type of allergy can be successfully treated, later allergies can be prevented.
EoE should be considered a later component of the ‘allergic march’ as per researchers. Allergic or Atopic March is the natural history in which many children successively develop a series of allergies. The more allergies a child has, the higher is its risk of developing EoE.
Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, Heart Care Foundation of India (HCFI), said, “When a child with EoE eats certain foods or breathes in certain substances, a type of white blood cell called eosinophils collect in the esophagus. These eosinophils are not normally found in the esophagus and can cause symptoms such as abdominal pain, swallowing difficulties, or vomiting. It often accompanies other autoimmune and allergic diseases, such as asthma and celiac disease. EoE can cause a child’s throat to stricture –rings, furrows and ridges appear in the throat wall. It can also sometimes cause complete closure of the throat. On a barium swallow X-ray, it may appear as if there are tight bands around the throat in multiple places.”
When compared to potentially life-threatening anaphylactic food allergies, EoE has low mortality, but high morbidity. It has slow-onset symptoms, such as pain in swallowing, reflux, stomach ache, even food impaction (in which food may become lodged in the esophagus).
Adding further, Dr Aggarwal, who is also the Group Editor of IJCP, said, “Currently, the only way to diagnose EoE is with an endoscopy and biopsy of the esophagus. An endoscopy is a medical procedure that lets your doctor see what is happening in your esophagus. During a biopsy, tissue samples will be taken and analysed. There is no cure for EoE. Treatments are aimed at helping patients manage their symptoms and prevent further damage.”
Some tips from HCFI
Food Testing Directed Diets For those diagnosed with specific food allergies, the doctor may remove specific foods from the diet.
Empiric Elimination Diets Eliminating major food allergens from the diet before any food allergy testing is also an accepted treatment of EoE. The foods excluded usually include dairy, egg, wheat, soy, peanut, tree nuts and fish/shellfish. Foods are typically added back one at a time with follow up endoscopies to make sure that EoE remains in control.
Elemental Diets In this diet, all sources of protein are removed from the diet. The patient receives their nutrition from an amino acid formula as well as simple sugars and oils. All other food is removed from the diet. A feeding tube may be needed since many people do not like the taste of this formula. This approach is generally reserved for children with multiple food allergies who have not responded to other forms of treatment.
