Allergen avoidance: avoid the allergy trigger
We also use the strategy of allergen avoidance for other allergies, such as hay fever. In doing so, you give “your” allergen a wide berth. The prerequisite is, of course, that your allergy triggers are known. In future, you will therefore have to eliminate all foods from your diet that are associated with eosinophilic esophagitis. Examples are dairy products with animal milk or wheat.
An elimination diet can help to identify these allergy triggers. You gradually give up certain foods and observe whether and what symptoms you have. A low-allergen (hypoallergenic) diet can also help people with EoE.
Eosinophilic esophagitis: treatment with medication
There are some medications that can alleviate the symptoms of EoE and prevent secondary damage. These are used, for example:
- Corticosteroids (“cortisone”): These drugs are very effective in reducing inflammation, alleviating symptoms and combating damage to the esophagus. There are preparations that only act locally on the mucous membrane of the esophagus. Commonly used active ingredients are fluticasone (as a metered dose inhaler) and budesonide (single ampoules for swallowing, syrup, or orodispersible tablets). The swallowing difficulties usually improve within a few days. However, you must use the cortisone for a longer period of time, but at a lower dosage (maintenance therapy). Otherwise the inflammation in the esophagus will flare up again within a few weeks or months. If local corticosteroids do not help sufficiently, cortisone in the form of tablets can be considered – but only for a few weeks due to the side effects. They act throughout the entire body.
If corticosteroids do not help sufficiently, there are now new drugs that specifically target the eosinophilic blood cells:
- Biologics (monoclonal antibodies): Biologics can help if cortisone is not effective enough. Biologics are proteins that selectively block certain inflammatory messengers. We now have several antibodies against the messenger substance interleukin-5 (IL-5). These drugs intervene very specifically in the inflammatory process and can alleviate both the eosinophilic inflammation and the symptoms with virtually no side effects. They are available as injections or infusions.
Eosinophilic esophagitis: dilatation of the esophagus
If the symptoms do not improve even with medication, dilatation of the esophagus is a treatment option. However, it carries the risk of the already weakened esophagus rupturing in the event of eosinophilic esophagitis. In addition, the stretching is not particularly pleasant and often painful. We therefore only perform dilatation in patients with a narrowing of the esophagus where medication has not been successful or has not been successful enough. The procedure can be performed as part of a gastroscopy.
In general, it can be said that the treatment of eosinophilic esophagitis significantly improves the quality of life of those affected and restores many patients’ zest for life. With sufficient, consistent treatment, patients can live a largely normal everyday life. And they can usually eat a normal diet – which makes a decisive contribution to their life satisfaction.
