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Your Guide to Eosinophilic Esophagitis

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Allergic Rhinitis, Asthma, and Eosinophilic Esophagitis: How to Tell Them Apart

Medically Reviewed By Elizabeth Feuille, MD

Allergic rhinitis, asthma, and eosinophilic esophagitis (EoE) are chronic conditions of the immune system. They share some common symptoms. Allergic rhinitis can cause asthma and EoE.

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When you have allergic rhinitis, your immune system overreacts to dust, pollen, and pet dander and produces symptoms like sneezing, runny eyes, or wheezing.

Asthma is a chronic lung disease that may be triggered by the same irritants as allergic rhinitis. Eosinophilic esophagitis (EoE) causes white blood cells called eosinophils to build up in the esophagus and produce inflammation.

You can have more than one of these conditions, and some of their symptoms can be hard to tell apart. A healthcare professional can make a specific diagnosis and find the right treatment.

Symptoms of allergic rhinitis

Allergic rhinitis is triggered by a reaction to usually harmless environmental substances. Exposure to your allergic triggers causes the immune system to release chemicals such as histamine, which cause allergy symptoms.

Allergic rhinitis symptoms can be caused by the following irritants:

  • animal fur
  • chemicals, dyes, and scents
  • dust
  • foods like nuts, milk, seafood, and eggs
  • insect stings
  • medications
  • mold
  • pollen
  • ragweed

Allergic rhinitis symptoms can be mild or severe enough for emergency medical treatment. Common symptoms include:

  • coughing
  • itching
  • nausea and vomiting
  • shortness of breath
  • rashes
  • stuffed or runny nose
  • swollen eyes, lips, or tongue
  • wheezing

Symptoms of asthma

Exposure to allergens like pollen or pet fur can trigger asthma symptoms in some people. Asthma inflames and narrows the airways of the lungs. Asthma episodes can be serious if the airways narrow so much that it’s hard to breathe.

People with asthma may experience excessive mucus production and bronchial spasms — muscle contractions in the airways.

Common asthma symptoms include:

  • chest tightness
  • coughing
  • shortness of breath
  • wheezing

Symptoms of eosinophilic esophagitis

EoE is a much less common condition that affects the esophagus, the tube that connects your mouth and stomach. With EoE, the immune system overreacts to allergens, and high numbers of white blood cells known as eosinophils can be found in the esophagus leading to inflammation in the surrounding tissues.

Consistent inflammation may cause EoE symptoms.

Some EoE symptoms include:

  • chest pain
  • stomach pain
  • vomiting
  • heartburn
  • pain or difficulty to swallow
  • sensation of food getting stuck
  • reflux — the backup of stomach acids into the esophagus

Getting a diagnosis

A primary care doctor, allergist, or gastroenterologist can help explain symptoms like chest tightness, wheezing, and coughing.

A healthcare professional will ask about your medical and family histories and symptoms during an exam. An exam might also include checking your lungs, including lung function.

Blood, skin, or patch tests can help your doctor determine whether allergens are triggering your symptoms and, if so, which ones.

An endoscopy and biopsy are the only ways to confirm an EoE diagnosis. During an endoscopy, the healthcare professional places a flexible scope into your esophagus to look for inflammation.

A biopsy removes small pieces of tissue to check for eosinophils and inflammation under a microscope.

Next steps

Once you know which of the three conditions you have, you can get started on treatment. Avoiding your triggers is one way to prevent allergic rhinitis, asthma, and EoE episodes.

Asthma and allergy medications stop your immune system from overreacting and relieve symptoms during flare-ups. Some people may experience more than one condition.

For EoE, proton pump inhibitors (PPIs) and corticosteroids reduce inflammation in the esophagus. The injected biologic drug Dupixent (dupilumab) is the only medication approved by the Food and Drug Administration (FDA) to treat EoE. Dupixent may also lower inflammation in the esophagus.

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Medical Reviewer: Elizabeth Feuille, MD
Last Review Date: 2023 Mar 17
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