Eosinophilic esophagitis (EoE) is a chronic allergic inflammation of the esophagus that causes food to get stuck, difficulty swallowing, chest discomfort, and in some cases food impaction requiring emergency removal. It is more common in patients with other atopic conditions like asthma and eczema. Modern targeted treatments are now available.
EoE is a chronic, immune-mediated esophageal disease in which large numbers of eosinophils (a type of white blood cell associated with allergic inflammation) accumulate in the esophageal lining. The inflammation causes the esophagus to become narrow and stiff, producing the characteristic symptoms of food sticking, prolonged meal times, and food impaction.
EoE is increasingly recognized in both children and adults. It frequently occurs in patients with other atopic conditions — asthma, allergic rhinitis, eczema, and food allergy — reflecting shared Type 2 inflammatory biology. Diagnosis requires endoscopy with biopsy, but management often involves the immunologist alongside the gastroenterologist because the underlying disease is allergic in nature and many treatment options come from the immunology toolkit.
Diagnosis requires upper endoscopy with biopsy, performed by a gastroenterologist. Specific eosinophil counts on biopsy establish the diagnosis. Coordination with gastroenterology is part of standard care, with allergy and atopic comorbidity workup performed in parallel at Optimed Immunology.
Treatment options include dietary elimination strategies (six-food elimination, targeted elimination based on testing), swallowed (topical) corticosteroids, proton pump inhibitor therapy, and biologic therapy. Dupilumab (Dupixent) is FDA-approved for EoE in patients 12 years and older.
The right approach depends on the patient's preferences, prior treatment trials, comorbid atopic disease, and lifestyle. For patients with both EoE and severe asthma or eczema, a single biologic can address multiple conditions.
A first visit takes your complete history of swallowing symptoms, food impactions, and any associated atopic conditions. Coordination with your gastroenterologist for endoscopy and biopsy is arranged if not already complete. Treatment options are discussed in detail and the plan is individualized to your situation.
Donald L. McNeil, MD · Board Certified in Allergy & Immunology and Internal Medicine
This page is provided for educational purposes and does not substitute for clinical judgment or direct medical advice. Treatment decisions are individualized based on your full history, examination, and laboratory findings. If you have an emergency, call 911.