eosinophilic

Eosinophils are a type of white blood cell. They help fight off infections and play a role in your body's immune response. They can also build up and cause inflammation.

Normally your blood doesn't have a large number of eosinophils. Your body may produce more of them in response to:

• Allergic disorders
• Skin conditions
• Parasitic and fungal infections
• Autoimmune diseases
• Some cancers
• Bone marrow disorders

In some conditions, the eosinophils can move outside the bloodstream and build up in organs and tissues. This can happen in many different parts of the body, including the esophagus, heart, lungs, blood, and intestines. Treatment of eosinophilic disorders can vary, depending on the cause and which part of the body is affected. Steroids are often part of the treatment.

Eosinophilic esophagitis (EoE) is a chronic disease of the esophagus. Your esophagus is the muscular tube that carries food and liquids from your mouth to the stomach. If you have EoE, white blood cells called eosinophils build up in your esophagus. This causes damage and inflammation, which can cause pain, trouble swallowing, and food getting stuck in your throat.

EoE is rare. But because it is a newly recognized disease, it is being diagnosed more often. Some people who think that they have reflux (GERD) may actually have EoE.

Researchers are not certain about the exact cause of EoE. They think that it is an immune system/allergic reaction to foods or to substances in your environment, such as dust mites, animal dander, pollen, and molds. Certain genes may also play a role in EoE.

EoE can affect anyone, but it is more common in people who:

• Are male
• Have other allergic diseases, such as hay fever, eczema, asthma and food allergies
• Have family members with EoE

The most common symptoms of EoE can depend on your age.

In infants and toddlers::

• Feeding problems
• Vomiting
• Poor weight gain and growth
• Reflux that does not get better with medicines

In older children::

• Vomiting
• Abdominal pain
• Trouble swallowing, especially with solid foods
• Reflux that does not get better with medicines
• Poor appetite

In adults::

• Trouble swallowing, especially with solid foods
• Food getting stuck in the esophagus
• Reflux that does not get better with medicines
• Heartburn
• Chest pain

To find out if you have EoE, your doctor will likely:

• Ask about your symptoms and medical history. Since other conditions can have the same symptoms of EoE, it is important for your doctor to take a thorough history.
• Do an upper gastrointestinal (GI) endoscopy. An endoscope is a long, flexible tube with a light and camera at the end of it. Your doctor will run the endoscope down your esophagus and look at it. Some signs that you might have EoE include white spots, rings, narrowing, and inflammation in the esophagus. However, not everyone with EoE has those signs, and sometimes they can be signs of a different esophagus disorder.
• Do a biopsy. During the endoscopy, the doctor will take small tissue samples from your esophagus. The samples will be checked for a high number of eosinophils. This is the only way to make a diagnosis of EoE.
• Do other tests as needed. You may have blood tests to check for other conditions. If you do have EoE, you may have blood or other types of tests to check for specific allergies.

There is no cure for EoE. Treatments can manage your symptoms and prevent further damage. The two main types of treatments are medicines and diet.

Medicines used to treat EoE are:

• Steroids, which can help control inflammation. These are usually topical steroids, which you swallow either from an inhaler or as a liquid. Sometimes doctors prescribe oral steroids (pills) to treat people who have serious swallowing problems or weight loss.
• Acid suppressors such as proton pump inhibitors (PPIs), which may help with reflux symptoms and decrease inflammation.
• Monoclonal antibodies, which can reduce inflammation and may help with swallowing. They can be used in adults and children over age 12.

Dietary changes for EoE include:

• Elimination diet. If you are on an elimination diet, you stop eating and drinking certain foods and beverages for several weeks. If you are feeling better, you add the foods back to your diet one at a time. You have repeat endoscopies to see whether or not you are tolerating those foods. There are different types of elimination diets:
• With one type, you first have an allergy test. Then you stop eating and drinking the foods you are allergic to.
• For another type, you eliminate foods and drinks that commonly cause allergies, such as dairy products, egg, wheat, soy, peanuts, tree nuts and fish/shellfish.
• Elemental diet. With this diet, you stop eating and drinking all proteins. Instead, you drink an amino acid formula. Some people who do not like the taste of the formula use a feeding tube instead. If your symptoms and inflammation go away completely, you may be able to try adding foods back one at a time, to see whether you can tolerate them.

Which treatment your doctor suggests depends on different factors, including your age. Some people may use more than one kind of treatment. Researchers are still trying to understand EoE and how best to treat it.

If your treatment is not working well enough and you have narrowing of the esophagus, you may need dilation. This is a procedure to stretch the esophagus. This makes it easier for you to swallow.

An allergy is a reaction by your immune system to something that does not bother most other people. People who have allergies often are sensitive to more than one thing. Substances that often cause reactions are:

• Pollen
• Dust mites
• Mold spores
• Pet dander
• Food
• Insect stings
• Medicines

Normally, your immune system fights germs. It is your body's defense system. In most allergic reactions, however, it is responding to a false alarm. Genes and the environment probably both play a role.

Allergies can cause a variety of symptoms such as a runny nose, sneezing, itching, rashes, swelling, or asthma. Allergies can range from minor to severe. Anaphylaxis is a severe reaction that can be life-threatening. Doctors use skin and blood tests to diagnose allergies. Treatments include medicines, allergy shots, and avoiding the substances that cause the reactions.

Your blood is living tissue made up of liquid and solids. The liquid part, called plasma, is made of water, salts and protein. Over half of your blood is plasma. The solid part of your blood contains red blood cells, white blood cells and platelets.

Blood disorders affect one or more parts of the blood and prevent your blood from doing its job. They can be acute or chronic. Many blood disorders are inherited. Other causes include other diseases, side effects of medicines, and a lack of certain nutrients in your diet.

Types of blood disorders include:

• Platelet disorders, excessive clotting, and bleeding problems, which affect how your blood clots
• Anemia, which happens when your blood does not carry enough oxygen to the rest of your body
• Cancers of the blood, such as leukemia and myeloma
• Eosinophilic disorders, which are problems with one type of white blood cell.

The esophagus is the muscular tube that carries food and liquids from your mouth to the stomach. You may not be aware of your esophagus until you swallow something too large, too hot, or too cold. You may also notice it when something is wrong. You may feel pain or have trouble swallowing.

The most common problem with the esophagus is GERD (gastroesophageal reflux disease). With GERD, a muscle at the end of your esophagus does not close properly. This allows stomach contents to leak back, or reflux, into the esophagus and irritate it. Over time, GERD can cause damage to the esophagus.

Other problems include heartburn, cancer, and eosinophilic esophagitis. Doctors may use various tests to make a diagnosis. These include imaging tests, an upper endoscopy, and a biopsy.

Treatment depends on the problem. Some problems get better with over-the-counter medicines or changes in diet. Others may need prescription medicines or surgery.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

A food allergy is an abnormal immune system reaction to certain foods. Your immune system normally protects you from germs. But if you have a food allergy, your immune system mistakenly reacts to certain foods as if they were harmful. This reaction is usually mild. But in some cases, it can be serious or even life-threatening.

A food intolerance is different than a food allergy. If you have a food intolerance, you also have symptoms when you eat that food. But these are typically just digestive symptoms such as bloating and gas. Also, an intolerance is not an immune system reaction.

Most food allergies are caused by:

• Cow's milk
• Chicken eggs
• Crustacean shellfish, such as shrimp, crab, lobster, and crayfish
• Fish
• Peanuts
• Sesame
• Soy
• Tree nuts, such as almonds, walnuts, pecans
• Wheat

People with a food allergy may be allergic to more than one type of food.

Both children and adults can have food allergies. Some children will outgrow their food allergies. And sometimes people can develop food allergies as adult.

Certain factors can make you more likely to have a food allergy. They include:

• Having eczema, a disease that causes inflammation, redness, and irritation of the skin. Your immune system also plays a role in eczema.
• Having asthma or other allergies, such as hay fever.
• Your genes. Certain genes may influence the development of food allergies. And you are more likely to have food allergies if someone in your family has allergies, asthma, or eczema.

If you are allergic to a food you have eaten, you may have a variety of symptoms. These symptoms are not always the same for every person. And the symptoms that you get each time you eat the food may not always be the same. For example, your symptoms may sometimes depend on how much of the food you ate.

Food allergy symptoms usually start within a few minutes to two hours after you eat that food. They may include:

• Hives
• Flushed skin or rash
• Tingling or itchy sensation in the mouth
• Face, tongue, or lip swelling
• Vomiting and/or diarrhea
• Abdominal (belly) cramps
• Coughing or wheezing
• Dizziness and/or lightheadedness
• Swelling of the throat and vocal cords
• Trouble breathing

In rare cases, a food allergy can cause a life-threatening reaction called anaphylaxis. It may start out with some milder symptoms, but then it becomes more serious. It can lead to:

• Narrowed airways in the lungs
• Severe trouble breathing because of swelling in the throat
• Severe lowering of blood pressure and shock ("anaphylactic shock")
• Loss of consciousness

This is a medical emergency. Call 911 if someone is having the symptoms of anaphylaxis.

To find out if you have a food allergy, your health care provider will

• Ask about your symptoms, family health history, and medical history, including other allergies.
• Likely do a physical exam.
• Do food allergy testing. This could involve skin testing, blood testing, a food elimination diet, and/or an oral food challenge test. An oral food challenge test is the most accurate food allergy test.

There is no cure for food allergies. The only way to prevent a reaction is to avoid eating the food that you are allergic to.

There are medicines for people with food allergies. They include:

• Medicines to reduce food allergy symptoms, including antihistamines and corticosteroids.
• Medicines to reduce allergic reactions, including severe reactions.
• Epinephrine, a medicine to treat anaphylaxis. Your provider may give you a prescription for an epinephrine auto-injector. It is a device used to inject epinephrine when someone is having symptoms of anaphylaxis. If you have been prescribed one, it's important to learn how to use it and to carry it with you at all times.

If you have a food allergy, it's a good idea to have a medical alert bracelet that says what your allergy is.

Vasculitis is an inflammation of the blood vessels. It happens when the body's immune system attacks the blood vessel by mistake. It can happen because of an infection, a medicine, or another disease. The cause is often unknown.

Vasculitis can affect arteries, veins and capillaries. Arteries are vessels that carry blood from the heart to the body's organs. Veins are the vessels that carry blood back to the heart. Capillaries are tiny blood vessels that connect the small arteries and veins.

When a blood vessel becomes inflamed, it can:

• Narrow, making it more difficult for blood to get through.
• Close off completely so that blood can't get through.
• Stretch and weaken so much that it bulges. The bulge is called an aneurysm. If it bursts, it can cause dangerous bleeding inside the body.

Symptoms of vasculitis can vary, but usually include fever, swelling and a general sense of feeling ill. The main goal of treatment is to stop the inflammation. Steroids and other medicines to stop inflammation are often helpful.

NIH: National Heart, Lung, and Blood Institute