Allergies + Chronic GI Issues?

Anyone who has sneezed their way through a pollen-filled spring or thought twice about putting peanuts in an elementary school lunchbox has at least a basic understanding of allergies. Ragweed pollen, shellfish and pet dander are common allergens that can trigger reactions ranging from itchy eyes to anaphylactic shock. Eosinophilic gastrointestinal disorders (EGID) are a rare group of allergies that cause inflammation in the gastrointestinal tract. For patients with an EGID, their allergic reaction may cause difficulty swallowing or chronic vomiting instead of sneezing or itchiness.  

For over a decade, a team of pediatric allergy and gastroenterology researchers and specialists at Arkansas Children's has been one of the few sites in the country treating EGID in pediatric patients. The EGID team is celebrating a procedure now available at Arkansas Children's - transnasal endoscopies.  

 

Allergies and Endoscopies 

Approximately 30-50 out of every 100,000 people are diagnosed with EGID. The number has nearly doubled in the last decade, according to Robert Pesek, M.D., the medical director for the allergy, severe asthma and EGID clinics at Arkansas Children’s Hospital (ACH) and associate professor of allergy and immunology and pediatrics at the University of Arkansas for Medical Sciences. Interestingly, EGID diagnosis requires an endoscopy rather than a typical skin test. “There's no blood test,” Dr. Pesek said. “There's no other test besides an endoscopy that will make the diagnosis. The only way to be certain is to physically look inside the esophagus [or other affected area of the GI tract].” 

An EGID allergy can cause inflammation anywhere in the gastrointestinal tract, but most occur in the esophagus. To diagnose EGID, a pediatric gastroenterologist inserts an endoscope - a thin tube with a camera and other miniaturized tools at the end - into the esophagus, looking for signs of inflammation and collecting a tiny amount of tissue, a process called taking a biopsy. Typically, the endoscope is inserted through the mouth and requires sedation with a general anesthetic. For years, EGID patients required multiple sedations, first during their diagnostic endoscopy and again each year, to monitor treatment.  Dr. Pesek said some parents wished for alternatives to anesthesia and sedation. 

"Listening to parent perspective and always trying to push the envelope to provide better care options" motivated Arkansas Children's team members to pursue training and certification in transnasal endoscopies, which don't require sedation. During a transnasal endoscopy, the endoscope is inserted into the nose. A mild topical medication numbs the nasal passage. "You can feel something moving through your nose but no pain," Dr. Pesek said. He and many other EGID team members underwent the procedure, which takes less than 15 minutes, to understand what their young patients would experience. 

Elaine Odiase, M.D., the director of advanced and general endoscopy at Arkansas Children’s Hospital (ACH) and an assistant professor of pediatric gastroenterology, hepatology and nutrition at the University of Arkansas for Medical Sciences (UAMS), was the first pediatric gastroenterologist in Arkansas certified to perform pediatric transnasal endoscopies. 

"A sedation-free transnasal endoscopy allows patients to return to their regular activities immediately following the clinic visit," Dr. Odiase said. "Truly, this is a huge improvement in care for our eosinophilic esophagitis patients." 

EGID Treatments 

Treatment begins after an endoscopy confirms an EGID diagnosis. Milk, dairy, eggs, wheat, soy, nuts, fish and shellfish are the most common triggers for EGID allergies. One treatment option is a food elimination diet, which requires identifying which food triggers the allergy and developing a strict diet that avoids the specific food. An Arkansas Children's nutritionist helps families and caregivers who choose this option by educating them on reading food labels, suggesting alternatives to common foods and designing menus to ensure a balanced diet. Treating EGID with a food-elimination diet can be challenging. Caregivers and children must constantly monitor the ingredients of their food. 

Fortunately, in 2022, the U.S. Food and Drug Administration (FDA) approved two medications for treating EGID in some pediatric patients. 

• Dupixent treats various allergic diseases, including asthma, eczema and EGID. In 2022, the FDA approved Dupixent for children 12 and older. In early 2024, the FDA approved Dupixent for use in children ages 1 to 11 weighing at least 33 pounds. 
  
  
• Eohilia is an FDA-approved corticosteroid for treating EGID impacting the esophagus in patients 11 years and older. 
  
  

The EGID team at ACH is one of 16 members of the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR), a group of health care organizations dedicated to improving the lives of individuals with eosinophilic gastrointestinal disorders. Members of CEGIR directly contributed to researching the FDA-approved medications. Dr. Pesek said, "Being a member of the consortium has helped us stay on the cutting edge of what the field is doing. We learn from others, they learn from us, and we can all take better care of our patients." 

Dr. Pesek said the success of the EGID clinic and its benefits for patients directly reflect the emphasis on teamwork at Arkansas Children's. The collaborative effort includes allergists, nutritionists, gastroenterologists and otolaryngologists. 

*This article was written by the Arkansas Children’s content team and medically reviewed by Robbie Pesek, M.D.