Look for eosinophilic esophagitis in atopic patients. Among #EoE pts, 60% have allergic rhinitis, 60% have asthma, 20% have atopic dermatitis. Routinely ask: re dysphagia, compensatory feeding behaviors. #ACAAI22
Patients with IgE-mediated food allergy have a 10-fold risk of developing EoE. This explains the unmasking of EoE during OIT. #ACAAI22
Treatments for EoE include dietary restriction, medications, and dilation of strictures. #ACAAI22
Despite 75% of patients being atopic, success of testing-guided dietary elimination is not superior to empiric avoidance. Both work ~50-60% of the time. #ACAAI22
Need to balance efficacy of empiric dietary elimination with quality of life. Reasonable to start with milk avoidance +/- wheat/grains.#ACAAI22
Although IgE testing doesn't successfully guide dietary management in EoE, it may be useful to test to determine if patient is at risk for development of immediate-type hypersensitivity (loss of tolerance) with strict food allergen avoidance. #ACAAI22
Is there a role for aeroallergen immunotherapy (subcutaneous AIT) in the treatment of EoE? Maybe not for EoE alone, but treating for AR/asthma may improve EoE as well (or it might flare it temporarily). #ACAAI22
Dupilumab now approved for treatment of #EoE - 300mg SC weekly reduces peak intraepithelial eosinophil count as well as symptoms. #ACAAI22
Other anti-eosinophilic drugs have not yielded as favorable results in studies. Eos go down, but symptoms do not. Why? Because despite the name, there is more to Eosinophil Esophagitis than eosinophils alone. #ACAAI22
We need novel, less invasive ways to measure esophageal inflammation that do not require general anesthesia. #ACAAI22
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