What are some environmental allergies
Substances that cause allergic reactions are called allergens.
The more common allergens include:
- grass and tree pollen – an allergy to these is known as hay fever (allergic rhinitis)
- medicines – including ibuprofen, aspirin and certain antibiotics
- insect bites and stings
- dust mites
- food – particularly nuts, fruit, shellfish, eggs and cows’ milk
- animal dander, tiny flakes of skin or hair
- mould – these can release little particles into the air that you can breathe in
- latex – used to make some gloves and condoms
- household chemicals – including those in detergents and hair dyes
Most of these allergens are generally harmless to people who are not allergic to them.
How to manage an allergy
In many cases, the most effective way of managing an allergy is to avoid the allergen that causes the reaction whenever possible.
For example, if you own a food allergy, you should check a food’s ingredients list for allergens before eating it.
There are also several medicines available to help control symptoms of allergic reactions, including:
- antihistamines – these can be taken when you notice the symptoms of a reaction, or before being exposed to an allergen, to stop a reaction occurring
- lotions and creams, such as moisturising creams (emollients) – these can reduce skin redness and itchiness
- decongestants – tablets, capsules, nasal sprays or liquids that can be used as a short-term treatment for a blocked nose
- steroid medicines – sprays, drops, creams, inhalers and tablets that can assist reduce redness and swelling caused by an allergic reaction
For some people with extremely severe allergies, a treatment called immunotherapy may be recommended.
This involves being exposed to the allergen in a controlled way over a number of years so your body gets used to it and does not react to it so severely.
Is it an allergy, sensitivity or intolerance?
A reaction produced by the body’s immune system when exposed to a normally harmless substance.
General Information About Eosinophilic Esophagitis
What is the upper gastrointestinal tract?
The upper gastrointestinal includes the parts of the body that break below and digest the food we eat.
In a wave-like movement, called peristalsis, muscles shove food and liquid along the digestive tract. The involvement of the upper GI tract includes the following:
- The first major muscle movement is swallowing food or liquid. The start of swallowing is voluntary, but once it begins, the process becomes involuntary and continues under the control of the nerves.
- Where the esophagus and stomach join, there is a ring-like valve that closes the passage between the two organs.
As food nears the valve, the surrounding muscles relax and permit food to pass into the stomach. The valve then closes.
- The food then enters the stomach, which completes three mechanical tasks of storing and mixing the food, then emptying it into the little intestine.
- The esophagus, which is the muscular tube through which food passes from the throat to the stomach.
- The food is digested in the little intestine and dissolved by the juices from the pancreas, liver, and intestine and the contents of the intestine are mixed and pushed forward to permit further digestion.
What is an eosinophil?
An eosinophil is one of several types of white blood cells normally found in blood and certain tissues.
Eosinophils assist engulf and kill bacteria and microorganisms such as parasites. They also participate in the control of allergic reactions and diseases. Eosinophils normally function to protect the body.
What is an eosinophil-associated disorder?
An eosinophil-associated disorder is a disease state in which there are too numerous eosinophils in a specific organ or organs, often in the gastrointestinal tract.
Too numerous eosinophils are often associated with abnormal symptoms. The long-term effects of too numerous eosinophils in a given area of the body are not known.
How common is eosinophilic esophagitis (EoE)?
It is estimated that approximately 55 patients per , people in the United States own EoE. This may vary by region.
Was my kid born with EoE?
Children are probably not born with EoE but develop it over time. They may be born with a predisposition to the disorder.
Do adults get EoE?
Adults do get EoE. It can develop in childhood and persist into adulthood. Some people first experience EoE as an adult or only get a diagnosis once in adulthood.
Overall increased awareness of the disorder has improved disease recognition and the need for endoscopic biopsies.
Is it harmful if someone only has a few eosinophils in their esophagus?
The presence of eosinophils suggests that there is inflammation in the esophagus. Inflammation should always be treated and should not be ignored. However, how numerous eosinophils is “too many” and how endless is “too long” is yet to be determined.
Are certain people more likely to get EoE?
Although anyone can get EoE, boys tend to develop it more often then girls—approximately three to one.
What are the symptoms of EoE in infants?
Infants with EoE generally own symptoms similar to reflux, including spitting up, irritability, vomiting and feeding refusal.
Some children may also experience growth problems.
What are the symptoms of EoE in toddlers?
EoE symptoms in toddlers are similar to those in infants, but they may also complain of abdominal pain or own trouble transitioning to solids.
What are the symptoms of EoE in school-aged children?
School-aged children may own reflux-like symptoms and may also vomit intermittently. They may own difficulty swallowing but this may be hard for them to explain.
What are symptoms of EoE in older children and teens?
Symptoms in older children and teens are similar to every of the other age groups, but may also include complaints about difficulty swallowing or food getting stuck in the esophagus.
Who should be tested for EoE?
Patients with symptoms listed at the top of this sheet that do not reply to medical treatment may be tested for EoE.
This is especially true for those who own significant difficulty swallowing solid foods.
Is EoE is hereditary?
EoE may be more common in families. Family members should be tested if they own symptoms.
Do children outgrow EoE?
There is limited data on long-term outcomes of EoE.
Can inflammation of the esophagus be cancerous?
Limited adult data suggests that inflammation does not lead to cancer, but it is too early to know for certain.
Any inflammatory process that persists from childhood to the adult years must be of concern.
What happens if someone with an eosinophilic disorder is exposed to an “unsafe” food?
EoE reactions may not happen immediately. Generally, if a kid is exposed to an “unsafe” food, he or she may experience a flare up in symptoms within a few days.
Are the symptoms of EoE the same in adults and children?
Symptoms are similar, but adults typically own difficulty swallowing or food getting stuck in the esophagus.
Adults are more likely to own strictures that need to be dilated.
What is a stricture?
EoE can cause changes in the tissue lining the esophagus that may result in a stricture, or narrowing of the esophagus. This is thought to happen as a result of inflammation in some children and adults with EoE. Food may not be capable to pass from the mouth to the stomach when a stricture forms.
How are strictures treated?
Esophageal strictures are generally treated by dilation or stretching the esophagus. To do this, a endless cylindrical rubber tube into the mouth and esophagus or by placing an inflatable balloon through the endoscope into the esophagus.
These procedures can cause pain and tears in the esophagus. Patients and their families should discuss these procedures and understand the risks.
Where a substance causes unpleasant symptoms, such as diarrhoea, but does not involve the immune system.
People with an intolerance to certain foods can typically eat a little quantity without having any problems.
Sheet final reviewed: 22 November
Next review due: 22 November
What is allergy?
Allergy is an immunological hypersensitivity mediated by immunoglobulin E antibody (IgE).
It is not a disease itself, but a mechanism leading to diseases such as rhinoconjunctivitis, urticaria, asthma and anaphylaxis. A normally harmless substance — love pollen, food or cat saliva — will cause the immune system to defend the body against it. In an allergic reaction the mast cells release a chemical called histamine, which is the primary cause for the allergic symptoms.
Allergies can be seen in numerous organs, but most commonly they affect the skin and mucous membranes, as these are the barriers between the body and the exterior environment. Pollen allergy causes itching in the eyes and a runny nose.
Contact allergies can induce a rash. Food allergies cause itching in the mouth as well as abdominal pain and vomiting.
The most severe allergic reaction is anaphylaxis. It can rapidly lead to a life-threatening condition where blood pressure drops and breathing may be obstructed because of throat swelling.
Allergy often starts at an early age. In most cases it persists through the life, but the symptoms may decrease, and some people outgrow their allergy entirely.
Sometimes other reactions are incorrectly referred to as allergy. For example, irritating or toxic substances can cause symptoms in the skin or abdomen that resemble an allergic reaction.
Occasionally, sensitivity to certain foods, such as lactose intolerance, is also being called allergy. However, only the immune-mediated hypersensitivity is true allergy.
Allergy starts with a sensitization phase that doesn’t yet cause allergic symptoms, but wires the immune system to recognize the allergen. The actual allergic reaction is launched upon the next encounter of the allergen and every time after that.
What are Environmental Allergens?
Environmental allergens are the substances in our environment to which you become allergic. Allergens can be pollens, which are released into the air by trees, grasses and weeds.
Allergens can also be pet dander (skin cells and proteins that every mammals normally shed) and pet saliva. Dust mites (microscopic mites that live in carpet, bedding and upholstery) and cockroaches can make allergic substances as well. Finally, mold can also be an environmental allergen.
Why do I own allergies?
The predisposition or risk to develop allergies is inherited from your parent(s). If you are at risk for developing allergies and are exposed to certain allergenic substances, you may become allergic. Developing allergies to substances in your environment takes time. For allergens that are present every year circular, such as pet dander and dust mites, allergies can develop over a period as short as a few months.
For allergens that are only present for short periods of time, such as pollens and molds, allergies often take several years to develop. Science has not yet sure why some people who are at risk develop allergies and other people who are at risk do not.
How do I know if I am allergic to allergens in my environment?
The classic nasal symptoms of environmental allergies include sneezing, itching, runny nose, and stuffy nose.
Allergies can also affect the eyes by causing redness, itching, watering or swelling. Some patients react to physical contact with allergens in the environment by developing hives or a rash. Your doctor can then confirm the diagnosis of allergy by allergy testing.
How are allergies treated?
Allergies can be treated in several ways:
1) AVOIDANCE is the best method to prevent your allergic symptoms, but is not always possible. Once you know to which allergens you own allergies, you can better attempt avoidance.
2) MEDICATIONS Your doctor may prescribe one or more medications for your allergy symptoms.
Antihistamines come in oral and topical forms. These medications work best in controlling or eliminating sneezing, itchy eyes & nose, or runny nose but NOT the best choice for stuffy nose. Topical Nasal Medications or Nasal Sprays work by shrinking the swelling in your nose and treating the allergic process occurring in your nose. This in turn decreases the ability of that tissue to react upon allergen exposure. Along with nasal rinse, it is an excellent choice for mitigating nasal congestion. Nasal Saline Washes and Irrigation are not technically medications.
Washing your nose with salt water (saline) is effective for clearing out congestion, washing away pollens and other allergens sitting on your nasal tissue, and reducing post nasal drainage. Most of our patients discover this treatment extremely helpful.
3) IMMUNOTHERAPY is also known as allergy shots. Immunotherapy is generally for patients whose allergies are hard to control with available medications or patients who do not tolerate medications.
If you discover that your allergy symptoms own become disabling or medications are no longer providing adequate relief, immunotherapy should be considered.
The decision to start immunotherapy should be discussed with your doctor. If you own more questions or concerns about immunotherapy, please enquire your doctor.
Eosinophilic esophagitis also known as EoE, is a relatively newly recognized disease that is characterized by eosinophils (allergy cells) building up in the lining of the esophagus.
The eosinophils cause inflammation in the esophagus, which may cause the following symptoms:
- Difficulty feeding, including feeding refusal and feeding intolerance
- Reflux-like symptoms
- Abdominal pain
- Poor weight gain
- Chest pain
- Decreased appetite
- Trouble swallowing
- Food impaction (when food gets stuck in the throat)
The reasons why some people own EoE are not fully understood.
Research has shown a strong connection between food allergies and EoE. Environmental allergens may also frolic a role in this disease but more research is needed. What we do know is that EoE is a chronic disease that can be managed through diet and/or medical treatment. EoE is not life threatening; however, if left untreated it may cause permanent damage to the esophagus.
Many patients with EoE also experience gastroesophageal reflux disease (GERD), a chronic digestive disorder that is caused by the abnormal flow of gastric acid from the stomach into the esophagus.
It is not unusual for a patient to get treatment for GERD while also undergoing treatment for EoE. Study more about GERD.
At CHOC Children’s, our multidisciplinary gastroenterology and allergy teams work together to diagnose and treat EoE so that our patients can reduce or eliminate their symptoms, prevent future complications and live a happy life. We also understand that with an EoE diagnosis comes numerous questions about the disease, treatment and long-term health.
We own put together the most frequently asked questions we received from our patients and their families. These answers should not replace information or specific instructions provided by patients health care providers.
The exaggeration of the normal effects of a substance. For example, the caffeine in a cup of coffee may cause extreme symptoms, such as palpitations and trembling.
Questions About EoE Diagnosis
How is EoE diagnosed?
EoE is diagnosed by evaluating each child’s symptoms, whether the child’s symptoms improve while undergoing EoE treatment and signs of EoE found during an endoscopy.
Children with EoE generally show high numbers of eosinophils in the esophageal tissue. Greater than 15 eosinophils per high power field is generally considered suggestive of EoE. The endoscopist may mention seeing trachealization or furrowing (rings) in the esophagus, which is also suggestive of EoE.
EoE can resemble other medical conditions. Eosinophils may be seen in the esophagus in lower numbers in GERD patients. Both GERD and EoE patients may reply to acid blocker therapy with proton pump inhibitors.
Study more about GERD.
What is an endoscopy?
An endoscopy, also referred to as upper endoscopy, esophagogastroduodenoscopy and EGD, is a test using a special camera to glance at the lining of the esophagus, stomach and duodenum. Little tissue samples, called biopsies, are taken to assess under a microscope. Sedation is generally required to act out the procedure.
Study more about endoscopy.
What is a biopsy?
In the case of EoE diagnosis, a biopsy is a little tissue sample taken from the lining of the gastrointestinal tract that can be looked at under a microscope to assist diagnose EoE and other disorders.
How numerous biopsies should be taken to diagnose EoE?
EoE is a patchy disorder, so generally four to six samples are taken to increase the likelihood of finding the disease if it is present.
Is there a way to diagnose EoE without invasive tests or through a simple blood test?
Unfortunately, an endoscopy is the only way to positively diagnose EoE.
Blood tests and stool tests may be necessary to assist exclude other disorders, but no blood test is available to diagnose a primary eosinophilic disorder.
Will patients own to go through additional endoscopies and biopsies after the initial diagnosis?
Patients will likely need several endoscopies over time to monitor the child’s response to treatment.
How do doctors figure out which foods may be causing EoE symptoms?
Our specialists use a combination of the patients medical history and every available tests including skin prick, patch and food challenges to determine the foods causing EoE.
What is skin prick testing?
It is a simple procedure that rapidly detects whether the person has antibodies to an allergen, food or environmental allergen.
Using diluted solutions of specific allergens on plastic prongs, one of our allergy and immunology doctors pricks the surface of the child’s skin. A reaction to the skin test does not always mean that your kid is allergic to the allergen that caused the reaction. Skin tests provide quick results, typically taking 15 minutes, and are more sensitive than blood tests. Skin prick tests are typically followed up with patch testing.
What is patch testing?
It is a test that is used to detect delayed allergic reactions.
Actual food is used to test how a child’s body reacts to its presence. Foods that yield a reaction may also be causing EoE symptoms, however, this can only be sure after monitoring the kid when the food is restricted and then reintroduced. Study more about patch testing.
Information About EoE Treatment
How is EoE treated?
For children with EoE, the primary goal of treatment is to insure normal growth and development. Steroids and/or dietary modifications are the most common therapies. Treatment regimens are often hard to maintain and must be individualized according to each family’s concerns and lifestyles.
Study more about EoE treatment at CHOC Children’s.
Is it true that some children with EoE cannot eat food?
Most children can eat some food but every patient with EoE is a little diverse. Some patients must rely on specially designed formula for their nutrition. These diets are called elemental diets. Study more about the diverse types of diets used to eliminate EoE symptoms.
What medications assist EoE?
Some patients with EoE take swallowed steroids to destroy the eosinophils, fight inflammation and permit healing to take put. The products that are used for EoE treatment were originally studied in are approved for use in children.
In fact, some of the steroids are approved for children as young as 12 months.
Some patients with EoE may also own allergy symptoms that require daily medications. Not every patient with EoE will need allergy medicine.
New therapies called biologics own been studied in patients with EoE. It is not known how helpful these man-made antibodies will be in the future.
Where can I get more information on treatments for eosinophilic disorders?
For more web-based resources on eosinophilic esophagitis, please refer to our list of online resources.
Where can I get more information on experimental treatments?
More information on experimental resources is available through the American Partnership for Eosinophilic Diseases and the National Institutes of Health.
Are there side effects from topical steroids such as fluticasone and budesonide?
The human mouth and throat contain numerous organisms including bacteria and yeast.
Sometimes when medications love these are taken, little amounts of residue remain on the surface of the mouth and throat. This change can permit yeast organisms to multiply and cause soreness and trouble swallowing. This side effect can be eliminated by gargling with water and spitting after each use.
Do patients with EoE need allergy shots?
Allergy shots to environmental allergens and their effect on EoE has not been studied.
What is an allergy blood test?
Allergies are a common and chronic condition that involves the body’s immune system. Normally, your immune system works to fight off viruses, bacteria, and other infectious agents.
When you own an allergy, your immune system treats a harmless substance, love dust or pollen, as a threat.
To fight this perceived threat, your immune system makes antibodies called immunoglobulin E (IgE).
Substances that cause an allergic reaction are called allergens. Besides dust and pollen, other common allergens include animal dander, foods, including nuts and shellfish, and certain medicines, such as penicillin. Allergy symptoms can range from sneezing and a stuffy nose to a life-threatening complication called anaphylactic shock. Allergy blood tests measure the quantity of IgE antibodies in the blood. A little quantity of IgE antibodies is normal.
A larger quantity of IgE may mean you own an allergy.
Other names: IgE allergy test, Quantitative IgE, Immunoglobulin E, Entire IgE, Specific IgE
What causes allergies?
Allergies occur when the body’s immune system reacts to a specific substance as though it’s harmful.
It’s not clear why this happens, but most people affected own a family history of allergies or own closely related conditions, such as asthma or eczema.
The number of people with allergies is increasing every year.
The reasons for this are not understood, but 1 of the main theories is it’s the result of living in a cleaner, germ-free environment, which reduces the number of germs our immune system has to deal with.
It’s thought this may cause it to overreact when it comes into contact with harmless substances.
Getting assist for allergies
See a GP if you ponder you or your kid might own had an allergic reaction to something.
The symptoms of an allergic reaction can also be caused by other conditions.
A GP can assist determine whether it’s likely you own an allergy.
If they ponder you might own a mild allergy, they can offer advice and treatment to assist manage the condition.
If your allergy is particularly severe or it’s not clear what you’re allergic to, they may refer you to an allergy specialist for testing and advice about treatment.
Find out more about allergy testing
Symptoms of an allergic reaction
Allergic reactions generally happen quickly within a few minutes of exposure to an allergen.
They can cause:
- a runny or blocked nose
- red, itchy, watery eyes
- a red, itchy rash
- wheezing and coughing
- worsening of asthma or eczema symptoms
Most allergic reactions are mild, but occasionally a severe reaction called anaphylaxis or anaphylactic shock can happen.
This is a medical emergency and needs urgent treatment.