Questions from Webinar Featuring Dr. Carla Davis

We received so many wonderful questions during our Eos Support Webinar featuring Dr. Carla Davis about the chronic nature of EGIDs that we did not have time to discuss all of the questions we received. Dr. Davis kindly answered additional questions to share here on our website.


When doing dietary testing, you have to eliminate, get a clean scope, then introduce the food, clean scope, etc. How is it determined if your EoE trigger is environmental?
If your EoE triggers are seasonal, then an EGD in and out of the season when your allergen is high might help, but it is complicated if your triggers are not seasonal or if there are food changes at the same time when the season changes. Typically, if the patient is allergic to pollen or other seasonal allergies, I will have them pay attention to any symptoms during the season or time of exposure.
If the EoE trigger is environmental, can antihistamines be used to treat?
Antihistamines can treat the rhinitis and other symptoms but there is no evidence that anithistamines will help the inflammation in the esophagus.
Is it common to have low ferritin level but normal haemoglobin?
A lower-than-normal ferritin level can indicate that you have an iron deficiency, which can happen when you don’t consume enough iron in your daily diet. This can occur with a normal haemoglobin level. 
What is the side effect for taking the oral steroid for growing child?
Steroids do not tend to cause significant side effects if they’re taken for a short time or at a low dose. Sometimes they can cause unpleasant side effects, such as an increased appetite, mood changes, and difficulty sleeping. This is most common with high dose steroid tablets. The side effects will usually pass once you finish the treatment, but do not stop taking your medicine without speaking to your doctor. Stopping a prescribed course of medicine may cause further unpleasant side effects (withdrawal symptoms).
Do you have any data on number of patients at your institution who are lost to follow up? What happens to them?
Great question. We have not systematically tried to reach out to the patients lost to follow up at our center, but we commonly see patients after 2-4 years even though we asked them to come back after 1 year. Typically, they have been managing their disease with dietary avoidance and bearing with symptoms until they can’t take the symptoms anymore or they want a change in management or there is a life transition like moving to college of coming out of college. Only a couple of times have I seen a patient who I thought had EoE which resolved. One was due to a drug allergy exposure and the other had allergen immunnotherapy and did well afterwards.
My brother recently had a steroid injection in his esophagus during an EGD for EOE and is doing much better. I am hoping he continues to do well. Are there studies showing the steroid injection works well for patients?
There are no studies with conclusive findings that intralesional steroid injections are an effective treatment in EoE. These injections have been utilized for the end stage lesions (for example strictures) with mixed results. There is no evidence this treatment has long term efficacy.
Can you kindly discuss FPIES and it's relation to EOE?
FPIES is a different entity from EoE when comparing the inflammatory mechanisms that cause the symptoms. However, they are both what is called “non-IgE mediated” diseases. This means they are not characterized by the allergy antibody (IgE) that mediates immediate classic food allergy symptoms like hives, coughing, and/or anaphylaxis. Both FPIES and EoE can be helped with food allergen avoidance. FPIES typically resolves over time and EoE does not resolve.
How do we join the Texas Childrens Hospital (TCH) studies? Do we have to be a TCH patient?
To join the Texas Childrens Hospital studies, call (832) 824-3398, our food allergy study nurse line, and leave a message! You will hear from one of our research coordinators about the available studies.

Thank you again to Dr. Davis for a wonderful webinar!

Learn more about APFED’s Eos Support Webinar Series.