Analysis: Since it was formally recognised in 1993, the chronic allergic disease Eosinophilic Oesophagitis has become increasingly prevalent in Ireland and around the world, and heavily impacts the quality of life for patients diagnosed.
Food allergies as well as other allergic disorders are increasing worldwide year-on-year and what were once deemed rare allergic diseases are becoming more prevalent.
Eosinophilic Oesophagitis (EoE) is an emerging chronic allergic disease of the oesophagus and is more recognised now as an increasing clinical problem, affecting as many as 16 in 100,000 people in Europe.
Although EoE is a rare disease, its prevalence is increasing since its discovery approximately 20 years ago. It was first described in 1993 by an Irish trained surgeon Dr Stephen Attwood and his colleagues in the United States.
Since then, EoE has been included within the 'allergic march', whereby patients have an increased chance of being diagnosed with multiple allergic conditions, such as asthma, atopic dermatitis, and rhinitis.
EoE gets its name from the immune cells eosinophils. These immune cells make up just 1% of the total white blood cell population forming the immune system and are significantly increased in allergies and the oesophagus of EoE patients. It can impact people of any age, with males three times more likely to develop the disease than females.
In Ireland, statistics show that approximately 5% of children, and 3% of adults suffer from food allergies. EoE is an oesophageal specific food allergic disease where it is thought that the oesophageal epithelial barrier, the physical boundary between external environmental particles such as food and the underlying immune system, is broken causing inflammation.
This broken barrier is seen throughout other allergic conditions, such as asthma atopic dermatitis, and allergic rhinitis, and further solidifies EoE as a member of the growing allergic march.
Common symptoms associated with EoE include difficulty swallowing, acid reflux, abdominal pain, and food impaction within the oesophagus.
Children with EoE are often deemed as 'fussy eaters' and may lack the proper skills to communicate their symptoms, therefore weight loss is sometimes evident among younger patients. As a result, patients with EoE and families can experience very poor quality of life.
Food triggers for patients suffering from EoE vary from person to person, with the most common triggers being dairy, egg, soy, peanut/treenuts, seafood/shellfish, and wheat.
Environmental allergens, such as pollen, dust mites and air pollution have shown to contribute to EoE rates with some patients displaying seasonal variation with diagnoses in spring and summer.
EoE is a disease with no cure and current mainstays for treatment include elimination diets, acid suppression, and topical corticosteroids. Acid suppressors (proton pump inhibitors) reduce the build-up of acid in the stomach and have been shown to reduce inflammation in a sub-population of patients with EoE.
Why has there been a global increase in food allergies? New Brainstorm video based on an article by Orla Cahill @WeAreTUDublin @IrishResearch - video by @_LauraGaynor pic.twitter.com/gv9XvLkJix
— RTÉ Brainstorm (@RTEBrainstorm) March 6, 2020
Currently, there is only one drug available that has been approved by the European Medicines Agency for EoE and it is a corticosteroid called Jorveza. This drug dissolves on the tongue and is swallowed, mixes with saliva and coats the lining of the oesophagus and inhibits inflammation.
Alternatively, some patients may observe diet therapy, focusing on elimination of the food allergen in question, to reduce chronic oesophageal inflammation.
Given that current treatment options for patients with EoE are limited and focus mainly on reducing inflammation and achieve little in addressing the frontline issue of the impaired barrier, there is a need for better understanding into the basic molecular mechanisms of defective barrier in this disease so that new therapeutic strategies can be conceived.
The Allergy, Inflammation and Remodelling Research (AIRR) Laboratory at Maynooth University, led by Dr Joanne Masterson, was established through funding from Science Foundation Ireland Future Research Leaders Award to develop Ireland's first research centre of excellence studying mechanisms underlying EoE and the development of new treatment options.
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From Louise McSharry on 2FM, this week's 'How to be an Adult' is all about food! Our Show Pro today is, dietician, Orla Walsh. There's an endless conversation of good food vs bad, good supplements vs bad, and it seems every aspect of diet is up for debate. Orla spoke to Louise about all the falsities and wrong beliefs with eating.
Our clinical collaborations include Children’s Health Ireland Crumlin and St. James’ Hospital Dublin as well as internationally in the USA forming collective efforts to better understand this new disease. AIRR laboratory research aims to heal the ‘leaky’ oesophageal barrier.
Our work, published in The Journal of Clinical Investigation, has identified a protein called Hypoxia Inducible Factor (HIF) which is switched off in EoE and may contribute to this ‘Leaky Oesophagus’.
Therefore, finding medicines to reactivate this may have a useful role in restoring the broken barrier. Other key avenues of our work focus on identifying other novel molecules regulating allergic inflammation and epithelial barrier.
Through our efforts in bringing better understanding and improved outreach and scientific communication surrounding this rare oesophageal disease, we hope our work will result in improved quality of life for patients with EoE.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
