How an Allergist Can Help with Eosinophilic Esophagitis

An allergist may not be the primary care provider for a patient with eosinophilic esophagitis (EoE), but the patients’ characteristics are similar to those of an allergy patient.

For starters, they’re suffering from a chronic condition. And for another, food elimination therapy may be just as beneficial for them. In an interview with MD Magazine®, Douglas Johnston, DO, an allergist/immunologist in Charlotte, NC, and Ellen Sher, MD, an allergist in Ocean, NJ, discuss the role of an allergist in treating or addressing EoE.

What is the allergist’s role in treating eosinophilic esophagitis?

Johnston: Well, I think that we're still learning a lot about EoE. There's been a lot of changes in our role along with it. So, these are very allergic patients in general, and there's a lot for the allergists to offer.

Sher: Yes, the allergist needs to be involved in co-managing these patients together with the gastroenterologist. They need to interpret the results. As Dr. Johnston was saying, these are very allergic patients that have a lot of comorbidities, and we know that the vast majority of patients—more than 90%—get better with food elimination. And somebody needs to be monitoring these patients, helping to get them through this kind of treatment process.

Johnston: It's often a team approach between gastroenterologist and allergists and oftentimes, the dietician as well.

Sher: We like to keep it very patient-centric, where we have a shared decision-making with the patient to decide whether or not they want to choose a medical therapy or a food elimination therapy, because there are various different options in this disease.

Johnston: Now that we have different treatment options, this is a good thing for patients. We can discuss the options, and they can really have a discussion with us to feel what's best for them. We think this would help them to stay on the treatment.

Sher: Absolutely. If they're involved in the decision-making, they're much more likely to follow through. And, whatever they decide doesn't have to be forever. They might change their mind 2 years down the road. You see that all the time.

Johnston: Yeah, this is a chronic condition. It's not going away. There's burden of diseases, and there’s burden of treatment. We often discuss how certain treatments can change over time, if that becomes a problem.

Sher: And I think that's one of the biggest misconceptions about this disease and the primary care community, is that they don't understand that this is a chronic, inflammatory disease that is not going away. So oftentimes, we see patients—then we don't see them for years, and then they end up coming back to us again 5 years later, 10 years later. But this disease is not going away.

Johnston: That's one of the roles of allergists, is to help patients to understand what's happening in this disease and that, just because they're feeling good, it doesn't necessarily mean they can stop what they're doing and expect that the disease is gone. So, I think that's an important role for us to really help patients understand what's happening.