Eosinophils are a normal cellular component of the blood and also of certain tissues, including spleen, lymph nodes, thymus, and the submucosal areas of the gastrointestinal, respiratory, and genitourinary tracts. Counts of 0 to 450 eosinophils per cubic millimeter of blood are considered within normal limits. Eosinophilic disorders occur when eosinophils are found in above-normal amounts in various parts of the body.

When the body wants to attack a substance, such as an allergy-triggering food or airborne allergen, eosinophils respond by moving into the area and releasing a variety of toxins. However, when the body produces too many eosinophils, they can cause chronic inflammation resulting in tissue damage. Eosinophilic disorders are diagnosed according to the location where the levels of eosinophils are elevated:

  • Eosinophilic esophagitis (esophagus)
  • Eosinophilic gastritis (stomach)
  • Eosinophilic enteritis (small intestine)
  • Eosinophilic colitis (large intestine)
  • Hypereosinophilic syndrome (blood and any organ)

There are many disorders where eosinophils have been found elevated in the blood or in different tissues. General categories of disease, each with examples of those that have increased levels of eosinophils, range from allergic disorders to endocrine disorders.

Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is an inflammatory disease of the esophagus. The esophagus is the tube that connects the mouth to the stomach.

With EoE, there are a large number of white blood cells called eosinophils in the esophagus.

Causes – EoE is caused by food allergies, and possibly airborne allergens.

Symptoms – typically resemble reflux disease but do not get better with anti-reflux medications. They may include:

  • Trouble swallowing

    Tinleigh's first scope, age 14 months

    Tinleigh’s first scope, age 14 months

  • Vomiting
  • Abdominal pain
  • Food getting stuck in the esophagus

Young children may also have slow or poor growth.

Diagnosis – Your child’s doctor may do some tests to find out if there are eosinophils in the esophagus. These tests include:

  • Endoscopy (using an instrument called an endoscope to look inside the esophagus)
  • Biopsy (a sample of tissue from the esophagus is removed and tested)
  • You have a scope every time you trial a new food. This could be every 2 – 3 months.

The following treatments are available for children with EoE:

  • Change or restriction in diet
    • Directed elimination – allergy testing to determine which foods to eliminate
    • Undirected elimination (empiric) – removes top common food allergens regardless of allergy testing, referred to as a 6FED
  • Elemental diet – amino acid-based formula that supplies the child’s caloric and nutritional needs

A dietitian will help make sure your child is getting the proper nutrition.

  • Prescription medications
    • Swallowed steroids – most common ones being fluticasone (Flovent) or budesonide (Pulmicort)
    • image

      Layton will have her first scope next week. She is 14 months.

      Source Cincinnati Childrens Hospital.