Allergic symptoms such as sneezing are similar to those of EoE (Eosinophilic Esophagitis)

Eosinophilic Esophagitis (EoE)

Eosinophilic esophagitis (EoE) is a recognized diagnosis that produces symptoms related to dysfunction of the esophagus. In EoE, large amounts of white blood cells, specifically eosinophils, collect in the inner lining of the esophagus resulting in inflammation. Typically, the esophagus is free from eosinophils and resulting inflammation, and so in EoE, a patient will begin to notice a difference in the way they can eat and swallow food. This condition can be difficult to diagnose as other conditions can present with eosinophils in the esophagus, and historically EoE has not been a common or well-known disease. Awareness has significantly improved however in the last decade, and patients are being recognized and diagnosed much earlier. This week, the FDA has approved the first ever treatment for EoE.

Symptoms of EoE

Many EoE patients also have symptoms of one or more allergic disorders like asthma, allergic rhinitis, atopic dermatitis (eczema) and food allergy. It is important for EoE patients to be properly assessed and tested for potential allergens as well as properly diagnosed for their atopic conditions. Similar to proper diagnosis, it is crucial that any and all allergic aspects of EoE can be properly treated in conjunction with management of the EoE. Patients benefit from a team of providers working together such as a primary care provider, allergy specialist, and gastroenterology specialist.

Early diagnosis of this chronic condition is important so patients can be educated and properly managed, sparing them from discomfort, malnutrition, and even life-threatening situations. An emergent situation can arise if inflammation becomes too great and causes narrowing in the esophagus, trapping swallowed food. In younger children, EoE typically presents with poor feeding, failure to grow properly, vomiting, reflux symptoms, and abdominal pain, whereas in adolescents and adults EoE most often presents with dysphagia (trouble or painful swallowing) and emergent esophageal food impactions.

Allergy Correlation

Allergic symptoms are similar to those of EoE
Allergic symptoms are similar to those of EoE

Airborne allergies can play a role, however adverse immune responses to food are the main cause of EoE in many patients. It can be more difficult to properly diagnose food allergies in EoE patients because many do not present with the typical symptoms associated with IgE mediated food allergy. Instead of immediate itching, flushing, hives and vomiting after ingestion of the offending food, the reactions can be delayed over hours or days. Milk, egg, soy and wheat are recognized as the most common triggers for EoE, however, conventional allergy tests often fail to detect sensitivity to the foods causing EoE. This is because most food allergy reactions in EoE are delayed and caused primarily by immune mechanisms other than classical IgE-mediated food allergy.

Diagnosis

Other than proper identification and diagnosis of atopic conditions, EoE must also be properly diagnosed itself as a disease. If EoE is suspected, a specialist performs an upper endoscopy, where a small tube with embedded camera is passed down the esophagus. The tube not only has a camera and light for inspection, but a small device to take samples, or biopsies of the esophagus. The biopsies of the esophagus are examined under a microscope for eosinophils and inflammation and are necessary to diagnose EoE. A provider looks for appropriate symptoms that were described above, visual inspection of the esophagus, and examination of tissue biopsies to make the final diagnosis of EoE.

Managing EoE

There are many viable options to managing EoE effectively. Food sensitivities or allergies can be managed by removing those offending foods from a person’s diet, but only under the direct guidance and supervision of a provider. A provider can advise eliminating a specific food, or a food group based on individual history, examination, and diagnosis.  This elimination approach can be helpful to some, but it is important to only remove what is advised, and a medical provider will closely monitor a person and regularly discuss nutrition and intake. Many times, a dietician is added to the medical care team to make sure a person is still receiving all the necessary nutrients. A provider’s goal is to carefully add back any foods that can in fact be tolerated and are proven not to incite eosinophils in the esophagus.

Aside from adjustments to a person’s diet, there are some medications providers use to help provide symptom relief and management of the EoE. It is important to note that aside from the first medication being approved by the U.S. Food and Drug Administration (FDA) to treat EoE, typical options for treatment include proton pump inhibitors and steroids. Proton pump inhibitors (PPIs) reduce acid production in the stomach and have also been found to be able to reduce esophageal inflammation in some patients with EoE. PPIs are very commonly used as a frontline therapeutic for EoE patients. If PPIs do not work for a patient, another option may be swallowed topical corticosteroids. Swallowing small prescribed doses of corticosteroids so they come in direct contact with and treat the inner lining of the esophagus is the most common treatment.

Amanda Hofmann, MPAS, PA-C, is a graduate of Duquesne University, in Pittsburgh, PA. After spending 8 years in clinical practice, she joined United Allergy Services where she is currently the Vice President of Clinical. Amanda is also the past president of the Association of PAs in Allergy, Asthma, and Immunology. 

United Allergy Services is also on FacebookLinkedInor TwitterSee other interesting and related articles on the UAS Blog.


Baseball season for allergy sufferers

Tips for Balancing Baseball and Allergies

Spring means longer days, warmer weather, and the beginnings of baseball! Unfortunately for some allergy sufferers, the start of the long-anticipated baseball season also means the time of year when allergens such as tree pollen are at an all-time high. Sneezing, wheezing, and itchy, watery eyes can make games or practice challenging for you or your little leaguer. Even more concerning? The thought of major league games and contact with baseball’s favorite sidekick...peanuts! You can still enjoy this spring and baseball season with a little planning for your allergies.

Eliminating all outdoor sports and activities may seem like the best decision, and for many, it is. However, if skipping out on baseball or other outdoor sports due to allergies just is not an option, we can help. Here are some tips that will help allergy suffers enjoy watching America’s pastime and PLAY BALL!

Airborne Allergy Tips

Check the weather forecast before heading to the game. When checking out the weather, it is good practice to also check the pollen counts in the area. Keep in mind that peak pollen times are typically in the first half of the day, specifically 5am 10am. Attending practices or games midday or in the afternoon may help to reduce exposures.

Baseball and outdoor allergies don't have to be in competition with one another. If you have a little leaguer, packing wet wipes is good practice. Wiping down their hands, face and neck can be helpful to combat those distracting allergy symptoms when out on the diamond. Also, make sure your favorite player is not relying on allergy medication that could make them drowsy. There are non-sedating medication options, or allergen immunotherapy that are worth discussing with their provider.

After a long practice or game, it is beneficial to change your clothing as soon as possible. Also helpful is an immediate shower, especially before crawling into bed. The shower will help to wash away any allergens that have adhered themselves to your skin or hair. This is especially important so that the allergens aren't transferred to your pillow or sheets, remaining in the immediate space you breathe in all night.

Planning for Stinging Insects and Food Allergies

If your allergies include stinging insects or even food, planning ahead can alleviate a lot of anxiety. Always make sure to carry a minimum of two epinephrine auto injectors if there is a known insect or food allergy. Make sure the epinephrine auto injectors can be accessed and administered within 60 seconds if the need arises.

If food allergies are present, especially peanut, legume, or tree nut, it can make the lyrics “Buy me some peanuts and Cracker Jacks” send shivers down your spine. Fortunately, most large baseball stadiums across the country have become aware of the dangers and distress surrounding food allergies and have started to offer peanut-free games or special accommodations for food allergy families with peanut-free designated seating. The Food Allergy Research and Education (FARE) organization typically releases an annual guide outlining which major league and minor league baseball stadiums offer peanut aware sporting events. Along with utilizing their helpful guide, FARE recommends “to reach out directly to the venue to learn more about their efforts”.

Some suggested questions to have ready when you contact the venue about are:

  • Are there any [peanut] allergy friendly games, sections, or suites available?
  • Does the venue utilize power washing for seating, and traffic pathways at the stadium?
  • Can you find ingredient lists or are they available upon request at the concessions?
  • Do they allow families to bring in their own safe meals and snacks?
  • Are emergency responders available to the public at every game, and are their sections closer to these personnel?

Planning and communication are key to enjoying baseball season and balancing your outdoor allergies. Talk to family, friends, coaches, players, and venues, to create a plan that is right for your family. However, missing out on baseball season does not have to be part of that plan. If you or your loved ones are not quite sure if allergies are playing a role, or if the over-the-counter allergy medication just is not cutting it, you have options. There is still time to see your provider and discuss allergy testing and begin allergen immunotherapy.

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About the Author:

Amanda Hofmann, MPAS, PA-C, is a graduate of Duquesne University, in Pittsburgh, PA. After spending 8 years in clinical practice, she joined United Allergy Services where she is currently the Vice President of Clinical. Amanda is also the past president of the Association of PAs in Allergy, Asthma, and immunology. 

 

United Allergy Services is also on FacebookLinkedIn, or Twitter. See other interesting and related articles on the UAS Blog.

https://unitedallergyservices.com/blog/patients/5-ways-tame-seasonal-allergies/

https://unitedallergyservices.com/blog/patients/versus-fall-alergies-will-win-7-tips-fight-allergies/


Tree pollen allergy explanation and avoidance tips

Tree Pollen Allergy

March is finally here, and that means so is Spring. Longer days, morning walks in the garden, rain showers and rainbows are excitedly on the horizon. However, if you have spring allergies you may be less excited about the season. Spring is typically defined as starting with the vernal equinox, and this year that is March 20. Of course, our allergies don't need a calendar to tell us that tree pollen, the main culprit of the sniffles and sneezes during spring allergy season, is already here!

Trees typically start producing pollen as early as January in the Southern areas of the U.S. The Northern and Central areas follow with pollen production sometime in February. One outlier, the Ashe Juniper Tree (commonly called Mountain Cedar) wreaks havoc in Oklahoma and Texas as early as December. Many trees will continue to produce pollen through June. Also, the milder the winter season, the earlier the trees begin producing pollen. Similarly, late winter or early spring snowfall leads to more pollen. The copious amounts of moisture produced when the snow melts allows a greater volume of pollen production.

Understanding Pollen

Pollen is a powdery substance made up of small spores that come from male trees and flowers. There are two primary types of pollen. The first pollen type, “Sticky Pollen” is produced by plants and trees that have bright and attractive flowers. This kind of pollen sticks to bees and is transported during flight, fertilizing other plants. These bright flowers are commonly thought to be spring allergy offenders. However, sticky pollen doesn't release much pollen into the air, so they are likely not driving most allergy symptoms.

The other type of pollen is “Wind-Blown Pollen”. This pollen comes from larger trees like pine and oak. The pollen is released in large quantities into the air, fertilizing other trees of the same species. The pollen that causes stereotypical allergy symptoms like nasal congestion, runny nose, and itchy eyes is usually the wind-blown pollen. This pollen is very small and light, and is easily spread by the wind for miles and miles.

Allergy sufferers can benefit from checking local pollen counts to determine the density of pollen in the air on any given day. Pollen counts are determined by collecting pollen on special rods. It is then counted under a microscope and calculated in grains per cubic meter of air. Pollen counts tend to be highest early in the day, or when wind picks up just before a large rainstorm. If you like dancing in the rain, however, you are in luck. During a rainstorm and immediately following, pollen becomes still and dormant due to the rain making it damp and heavy. As the air becomes warm and dry following the storm, the pollen count will become potent again.

Managing Tree Pollen Allergies

For tree pollen allergy sufferers, it is recommended to avoid densely wooded areas, especially in early spring when pollen is the most abundant. If possible, avoid planting trees around the house that can cause allergy symptoms. Pass on major tree offenders like oak, birch, maple, cedar, juniper, and eucalyptus (unless you can guarantee they are female trees). Instead, look for friendlier species such as dogwood, pear, plum, redbud, or crape myrtle.

Pollen counts are never zero, and allergy sufferers will not truly be able to avoid tree pollen in the spring. However, some practices may help alleviate the severity of symptoms. Try utilizing the air conditioner and keeping windows and doors closed at home and in the car. Also, using the dryer instead of hang drying clothing will help decrease pollen exposures. One benefit of COVID-19 is that wearing some masks will help to minimize the amount of pollen that reaches the nasal passages, especially when worn in outdoor settings. Tree pollen allergy suffers should also make a habit of changing their clothes after coming in from being outdoors, and bathing prior to getting into bed/laying on upholstered furniture.

If you know someone that has difficulty with morning walks in the garden and they are unsure whether tree pollen is a trigger for their spring nasal congestion, runny nose, post nasal drip, sneezing, and itchy watery eyes, you can suggest they see their provider for an allergy test. It may provide the clarity they are looking for!

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Amanda Hofmann, MPAS, PA-C, is a graduate of Duquesne University, in Pittsburgh, PA, and spent  8 years in clinical practice before joining United Allergy Services. Amanda is a past president of the Association of PAs in Allergy, Asthma, and Immunology and currently serves as Vice President of Clinical at UAS.

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