Fussy or picky eating is common in children. Thankfully, and to the relief of many parents, most children outgrow this phase.
However, something more serious may be happening for those who still clam up at mealtime. It could signify an allergic swallowing disorder called eosinophilic esophagitis (EoE).
EoE is a relatively new disease but a growing concern for allergists and gastroenterologists. The rare condition has nearly doubled in adults and children in the last two decades.
If you have concerns about your picky eater, here we answer six critical questions about the condition.
What is eosinophilic esophagitis?
EoE is a condition that causes swelling and irritation in the esophagus, the tube that carries food from your mouth to your stomach. This is caused by food and/or an environmental allergy, such as pollen.
Eosinophils, one type of white blood cell, are a part of the immune system that helps the body fight off attacks from infection. As a result, they help keep our bodies healthy. But when your body produces too many of them in your throat, they can cause an eosinophilic disorder.
“In the case of a child with a food allergy, when they eat something they are allergic to, their immune system mistakenly recognizes the food as harmful and releases chemicals, including histamines, to fight it off,” said Vinay Bandla, MD, a pediatric gastroenterologist with Banner Children's. “This can lead to symptoms of hives, itching, swelling and difficulty breathing.”
In some cases, a severe allergic reaction called anaphylaxis can occur, which can be life-threatening.
Who is at risk for this condition?
In recent years, health care professionals are seeing more patients with EoE. This may be mainly due to greater awareness of the condition.
Most cases of EoE are seen in people with other allergies, such as allergic rhinitis (also called hay fever) and asthma. These include food allergies, eczema and seasonal allergies. Food allergies are typically the leading cause of EoE, with foods like peanuts, tree nuts, dairy, soy, wheat, fish, shellfish and eggs as the main culprits.
What are the symptoms of eosinophilic esophagitis?
The symptoms vary from person to person and often change with age.
“The onset of symptoms typically occurs during childhood, with the majority of cases being diagnosed in children between the ages of 6 and 15,” Dr. Bandla said. “However, it can also occur in adults, and the symptoms may differ from those in children.”
Symptoms in infants and toddlers
- Spits up often or projectile vomits (throws up)
- Issues with feeding
- Refuses certain or all solid foods
- Poor weight gain or growth
Symptoms in children and teens
Symptoms in adults
- Heartburn or chest pain
- Acid reflux
- Trouble swallowing
Over time, irritation to the esophagus causes scarring. This can make it difficult for the esophagus to stretch normally and increases the risk of food getting stuck, known as food bolus obstruction, in your throat.
How is eosinophilic esophagitis diagnosed?
Because the symptoms of EoE can mimic many other diseases, such as gastroesophageal reflux disease (GERD), the first step is to rule out other possible conditions.
If your child is showing symptoms of EoE, your health care provider may recommend seeing a specialist, like a gastroenterologist or an immunologist/allergist, for an upper endoscopy. This test uses a tube that runs down the throat and takes pictures and several tissue samples, called biopsies. This helps the specialist see if there are high levels of eosinophils in the tissue.
How is eosinophilic esophagitis treated?
“Most children see improvement with changes to their diet and with medications, but treatment plans are often individualized and may vary based on how severe symptoms are and how they respond to treatment,” Dr. Bandla said.
EoE may be treated with medications, such as corticosteroids to help reduce inflammation and proton pump inhibitors to reduce stomach acid.
Your child’s specialist may also recommend food allergy testing where the skin is pricked and exposed to the most common food allergies to check for a reaction.
“This can help determine food triggers and guide modifications,” Dr. Bandla said. “An elimination diet may also be done to eliminate all potential allergens and gradually reintroduce them one by one to identify triggers.”
An elemental diet is another treatment option. This liquid, formula-based diet contains only amino acids and does not include any food-based protein sources.
Can my child outgrow eosinophilic esophagitis?
EoE is a chronic condition, so your child will not outgrow it. The long-term outlook with EoE can vary and depends on several factors, such as how severe it is, your child’s response to treatment, and overall health.
“EoE is thought of as a relapsing and remitting disease,” Dr. Bandla said. “Many people can manage their symptoms and maintain long-term remission, but others may experience relapses, especially if triggers are not avoided or if treatment is not continued.”
Eosinophilic esophagitis (EoE) is a condition that affects the esophagus and causes chronic irritation. While it is a relatively newer condition, several treatment options are available today, along with growing research.
Talk to your child’s provider if you are concerned your picky eater might have EoE.