Eosinophilic oesophagitis (EoE – or EE, if you are in the US) is a recognised but rare side effect of oral immunotherapy (OIT).

We now understand it as a spectrum of gut related OIT issues. The classic signs of oesophagitis are burning central chest pain, reflux of stomach contents up into throat/mouth, vomiting. Sometimes food gets stuck half way down after swallowing, which is really uncomfortable.

In young kids it may be tricky to pick up – they may just have reduced appetite and poor weight gain.

It is seen in most kinds of oral immunotherapy, but some kids (and adults) get it without it being related to food allergy.

To diagnose it requires endoscopy, which means a referral to a paediatric endocrinologist, and an anaesthetic. Raised eosinophils on a blood test can be a clue, but many allergic kids have this anyway.

Many kids doing OIT get the odd sore stomach, or gas, or nausea, usually these symptoms settle quickly and you can keep going with OIT.

If those symptoms become persistent and severe, you would be concerned about EoE – we would then reduce the dose but try to continue. 

We have never had to use any specific EoE treatment for any of our patients, but we can give omeprazole, which is often all you need.

You would only discontinue OIT if that wasn’t working – once you have stopped OIT, things generally settle by themselves. If not, a gastroenterologist can give a course of budesonide after confirming the diagnosis. This seems to work very well.

So we think of it as a rare but manageable side effect, which in some unlucky cases might stop progress with OIT.