Foreword

Article Outline

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Open any popular news magazine and you are likely to see an article about the increases in the prevalence of asthma in the United States over the past 2 decades. Less well publicized is that eosinophilic esophagitis, a condition that some have called “asthma of the esophagus” also appears to be on the rise. Until the past ten years, pediatricians didn't often consider a diagnosis of eosinophilic esophagitis in children with dysphagia. In this issue, Drs. C. Allan Pratt, Jeffrey Demain, and Melinda Rathkopf describe food allergy and eosinophilic gastrointestinal disorders and provide helpful clinical advice for practitioners.

Treatment of eosinophilic gastrointestinal disorders involves avoiding the food allergens that cause it (most frequently eggs, milk, soy, corn or wheat). Intriguing research using mice has also demonstrated a direct link between exposure to allergens that are breathed in and development of esophageal inflammation, possibly mediated by interleukin-5. When mice with interleukin-5 were given an allergen that induced asthma, all of them developed esophagitis. In mice that were deficient in interleukin-5 and received the same allergen, no esophagitis developed. This raises the question whether avoidance of aeroallergens might be considered in some patients, although this has not yet been carefully evaluated.

Dozens of questions about eosinophilic gastrointestinal disorders remain to be studied. We do not understand whether some children with these disorders should be expected to “outgrow” them as they do asthma. Nor do we understand why three or more children in some families are affected. Increasing recognition by pediatricians and nurses should lead to more research to help us better understand its etiology and ultimately prevent its occurrence.