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.