By Taylor Pasell, Allergychoices
As if sneezing and itching wasn’t enough, some people experience heartburn symptoms due to their environmental and/or food allergens. Throughout his 37 years as an allergist, Dr. George Kroker, partner at Allergy Associates of La Crosse and a co-author of the La Crosse Method™ Protocol, has seen many patients with complex allergy conditions who have experienced heartburn as a symptom of their allergy condition.
A common allergy condition that’s becoming increasingly recognized is eosinophilic esophagitis, or EoE. EoE is a buildup of disease-fighting white blood cells (called eosinophils) in the esophagus that cause symptoms like:
- Difficulty swallowing
- Pain when swallowing
- Chronic cough
- And for some, heartburn
In a susceptible individual, certain foods and airborne allergens can trigger eosinophils to accumulate in the esophagus, causing symptoms such as heartburn and pain with swallowing. There can also be a sensation of food “sticking” in the throat.
When these symptoms occur, most people take an antacid and hope for it to work its magic, but when it doesn’t, they often make their way to a gastroenterologist.
To determine if a patient has EoE, Dr. Kroker says, “The gastroenterologist would do an endoscopy, putting a scope down the esophagus and finding — with a biopsy — that there are too many allergy cells, i.e., eosinophils. ” Sometimes this problem will respond to certain kinds of acid blocking medications (i.e, “PPI responsive EoE”) but often there is no positive response.
Under these conditions, and after discovering an abundance of eosinophils and no response to acid blocking medications, patients are typically sent to an allergist to identify the offending allergen and treat the cause. Because there are no commercially available, standardized medications for EoE, lifestyle and diet modification, and allergy management are the often the best treatment.
For those with a determined food allergy, certain foods can cause flare ups in the esophagus, and desensitizing the body to that allergen with immunotherapy can help to eliminate heartburn and other EoE symptoms. Milk, wheat and eggs are some of the most common to cause issues in those with EoE.
Dr. Kroker has also seen patients with traditional seasonal allergies experience heartburn, too. He says, “There are actually patients who have been described in medical literature who have ‘seasonal EoE.’ Every fall, they feel heartburn, difficulty swallowing, a burning sensation in their throat, pain with swallowing, and then it goes away and gets better as the season changes.” Just like with food allergy, treating the cause of the environmental allergy can eliminate the response in the esophagus.
“We always try to find the cause behind the problem. By identifying causative airborne allergens and food allergens, we can then begin to treat the patient with immunotherapy and some avoidance measures to make them feel better,” Dr. Kroker explains. After testing and accurate diagnosis, he treats the offending allergens with sublingual immunotherapy, or allergy drops, and recommends diet changes based on test results and clinical judgement.
Regarding diet changes, the medical literature mentions 3 diet versions that can be helpful in managing EoE based on statistical analysis of foods that typically trigger EoE symptoms: 2 food, 4 food, and 6 food elimination diets. These “diet templates” are taken into consideration — along with the patient’s test results — in designing a diet for a patient. In addition, allergy drops slowly and safely introduce the patient’s body to increasing amounts of the offending allergen, creating long-term tolerance and fewer EoE and allergy-related symptoms.
Some patients wonder if using allergy drops will make symptoms worse. Due to the way allergy drops are delivered following the La Crosse Method Protocol, patients don’t seem to have the flare ups that are common with Oral Immunotherapy (OIT). Allergy drops are a safe and effective method that can be used effectively in children and adults alike. Read more about allergy drops for EoE.