If you are having problems with difficulty swallowing certain foods it may be a sign of a chronic allergic condition called, Eosinophilic Esophagitis (EoE). We are learning this condition is more common than we once thought. It occurs in children and adults and seen more in males than females. It is prevalent in families that have a history of allergic disease. In children it presents with refusal of food, poor growth, abdominal pain, reflux and vomiting. In adults, there is difficulty swallowing, worsened reflux, chest pain and food feeling like it is getting stuck going down. EoE occurs when there are an increased number of inflammatory cells called eosinophils or “allergy cells” in the esophagus which causes swelling and irritation. This makes it difficult to swallow when it flares up. In some people it can be triggered by food or by environmental allergies such as pollen or mold. How is it diagnosed? A gastroenterologist will perform a biopsy (tissue sample) of the esophagus using a small tube inserted through the mouth looking for these eosinophils. An allergist will identify triggers, monitor symptoms and coordinate care with other healthcare professionals on the patient’s team. EoE can be treated and managed through various dietary therapies, medication therapy or a combination of both. An important secondary therapy is using a proton pump inhibitor, anti-reflux medication, to rule out gastro esophageal reflux disease and it also helps to relieve symptoms in some cases. Compliance is critical and a dietician can help find replacement foods and ensure nutrition.