Top Tips for Laboratory Testing in Eosinophilic Esophagitis (EoE)

A friend of mine from school recently emailed me asking for guidance on testing for EoE. Here are some of the basics I start with:

Genova: IgG4 food sensitivity panel.
LabCorp or Quest: IgE food panel and an IgE regional inhalant panel, too. (These will include a total IgE level with them)
Comprehensive stool test with H Pylori and if possible, eosinophil protein X (EPX)
Nutrients including D, mag and zinc
SIBO breath test if symptoms warrant
Histamine & tryptase

All EoE cases I’ve had thus far have a combination of IgE and IgG4 positives- so I look at both. If I see inhalants, I look for cross reactions. For instance: If someone reacts to ragweed or birch, etc, they can cross react with a number of foods. Here’s a list you can look at accompanied by a nice write-up from American Academy of Allergy, Asthma & Immunology.
While the above article mostly talk about oral allergy syndrome (hallmark is an itchy mouth after eating certain foods), you’ll see that some EoE people get reflux from these foods and you need to eliminate them while you treat the gut and dampen inflammation.

Certain food reactions causing itchy mouth, throat pain or nausea–like soybean and some nuts—may become more severe (think anaphylaxis), especially during allergy their season, so pay close attention to those. An epipen and co-management with an allergist would be a good idea for these patients.

Tags: Eosinophilic Esophagitis lab testing Eosinophilic Esophagitis

Author: Kara Fitzgerald, ND

https://www.drkarafitzgerald.com/

Kara Fitzgerald, ND, received her doctor of naturopathic medicine degree from the National University of Natural Medicine in Portland, Oregon. She completed the first Counsel on Naturopathic Medicine-accredited post-doctorate position in nutritional biochemistry and laboratory science at Metametrix Clinical Laboratory under the direction of Richard Lord, PhD. Her residency was completed at Progressive Medical Center, a large, integrative medical practice in Atlanta, Georgia. Dr. Fitzgerald is the lead author and editor of Case Studies in Integrative and Functional Medicine and is a contributing author to Laboratory Evaluations for Integrative and Functional Medicine and the Institute for Functional Medicine (IFM)’s Textbook for Functional Medicine. With the Helfgott Research Institute, Dr. Fitzgerald is actively engaged in clinical research on the DNA methylome using a diet and lifestyle intervention developed in her practice. The first publication from the study focuses on reversal of biological aging and was published 04-12-2021 in the journal Aging. She has published a consumer book titled Younger You as well as a companion cookbook, Better Broths and Healing Tonics and has an application-based Younger You Program, based on the study. Dr. Fitzgerald is on the faculty at IFM, is an IFM Certified Practitioner and lectures globally on functional medicine. She runs a Functional Nutrition Residency program, and maintains a podcast series, New Frontiers in Functional Medicine and an active blog on her website, www.drkarafitzgerald.com. Her clinical practice is in Sandy Hook, Connecticut. Additional publications

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Top Tips for Laboratory Testing in Eosinophilic Esophagitis (EoE)

Author: Kara Fitzgerald, ND

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