Food allergy and eosinophilic esophagitis: Learning what to avoid

Food allergies have increased in prevalence significantly in the past decade and so, apparently, has eosinophilic esophagitis. Although the cause of eosinophilic esophagitis is unknown, allergic responses including food allergies have been implicated. This article reviews both conditions, focusing on how to detect and manage them.Food allergies can be classified as mediated by immunoglobulin E (IgE-mediated), non-IgE-mediated, or mixed. Their clinical presentation can vary from life-threatening anaphylaxis in IgE-mediated reactions to chronic, delayed symptoms as seen in eosinophilic esophagitis (a mixed reaction).The diagnosis of an IgE-mediated food allergy is made by taking a complete history and performing directed testing—skin-prick testing or measurement of foodspecific IgE levels in the serum, or both.Despite promising developments, food allergies continue to be treated primarily by telling patients to avoid allergens and to initiate therapy if ingestion occurs.Because most patients with eosinophilic esophagitis have a strong history of atopic disease and respond to allergen-free diets, a complete evaluation by a specialist in allergy and immunology is recommended.