How Is Eoe Diagnosed
When EoE is suspected, generally the first test is an upper endoscopy, in which a flexible tube with a small camera and a light on one end is used examine the esophagus. The endoscopy usually reveals characteristic features of EoE, such as concentric rings and linear furrows or vertical lines, as well as small white spots or plaques.
The diagnosis is confirmed if biopsies from the esophagus reveal the hallmark increase in eosinophils. Eosinophils are a relatively rare type of immune cell that play a prominent role in allergic disorders including EoE and asthma.
Difficulty Swallowing Post Nasal Drip And Throat Tightness
- Medical Author: Melissa Conrad Stöppler, MD
Last Editorial Review: 8/31/2020
While these symptoms are sometimes observed during an panic or anxiety reaction, they are very commonly associated with allergies and viral infections that cause sore throat, particularly if accompanied by other symptoms of upper respiratory infections like runny nose and cough. If you are concerned about your symptoms, seek the advice of your doctor.
While the list below can be considered as a guide to educate yourself about these conditions, this is not a substitute for a diagnosis from a health care provider. There are many other medical conditions that also can be associated with your symptoms and signs. Here are a number of those from MedicineNet:
How Is Allergic Esophagitis Diagnosed
Your healthcare provider will ask about your symptoms and when they began. Tell him or her if you know certain foods cause your symptoms. Tell him or her if you have any medical conditions or a family history of allergic esophagitis. You may also need any of the following:
- Allergy tests are used to see how your body reacts to certain allergens. The tests may show what is causing your allergic esophagitis.
- A barium swallow x-ray is used to take pictures inside your esophagus. You will swallow barium in a thick liquid before you have the x-ray. The barium helps any injuries show up better on the x-rays.
- Endoscopy is used to find any tissue changes. A scope is used to see inside the esophagus. A scope is a long, bendable tube with a light on the end. The scope is placed in your mouth and passed down your throat and esophagus. A camera may be hooked to the scope to take pictures.
- A biopsy is used to take tissue samples from your esophagus to be tested. The samples may also be checked for any other problems with your esophagus.
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How To Treat Dysphagia
Diagnosing the Cause of Dysphagia
The best treatment plan for difficulty swallowing will depend on the root cause of the issue. A specialized ENT doctor should be consulted to review your history, symptoms and lifestyle. The doctor will examine your nose, throat, chest and, if needed, digestive system. A laryngoscopy or endoscopy can help the doctor thoroughly examine the back of the nose and throat using a fiber-optic scope. An upper GI endoscopy or barium swallow can be used to analyze the gastrointestinal tract if GERD is suspected. Once the underlying condition causing your dysphagia is diagnosed, the doctor can decide on the best way to treat your symptoms and help you swallow normally once again.
Treating Allergy Related Dysphagia
If your ENT doctor determines that your swallowing problems are being caused by underlying allergies, there are several types of treatments that can help. Oral allergy medications may help temporarily reduce mucus production and inflammation, which can help you swallow more regularly for a short time. Our allergy experts recommend using allergy drops, also called sublingual immunotherapy drops, which is just a daily drop under the tongue. Just like allergy shots, allergy drops are customized for your unique allergies and designed to relieve or even eliminate your allergy symptoms long-term. By treating your allergies that cause inflammation, irritation, and post-nasal drip, you also treat your symptoms of dysphagia.
Stroke Or Transient Ischemic Attack
- Abnormal vision
A stroke occurs when blood flow is stopped by a clot in your brain or when theres a bleed in your brain. A transient ischemic attack often called a mini-stroke can cause similar symptoms as a stroke, but it lasts for less than 24 hours.
After a stroke or TIA, you may have weakened muscles of the oropharynx or it may affect your swallowing reflex. These both cause difficulty swallowing.
Treating stroke or a TIA
If you have symptoms of a stroke or TIA, immediately go to the emergency room. TIAs need to be taken as seriously as a stroke because they increase your risk of experiencing a full-blown stroke. Treatment includes anti-clotting medication and possibly surgery.
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How Is Anaphylaxis Treated
Someone with anaphylaxis needs help right away. The reaction can get worse very quickly. So doctors usually want people with allergies to carry injectable medicine called epinephrine. Epinephrine enters the bloodstream and works quickly against serious allergy symptoms.
Doctors prescribe auto injectors. These should always be with the person with allergies, including at school, sports, jobs, and other activities. The auto injector is small and easy to use.
If you’re prescribed epinephrine auto injectors, the doctor will show you how to use them. Always have two auto injectors with you in case one doesn’t work or you need a second dose.
Your doctor also might instruct you to take antihistamines in some cases. But always treat a serious reaction with epinephrine. Never use antihistamines instead of epinephrine in serious reactions.
Allergies And Difficulty Swallowing
It is possible to have difficulty swallowing as a result of blockage or swelling in the throat due to allergies. The bodys response to allergies can cause enough excess mucous to block or narrow the esophagus, causing inflammation or discomfort and leading to symptoms of dysphagia. If prolonged, this inflammation can become esophagitis, which is caused by the presence of any unfamiliar substance affecting the esophagus. An intense allergic reaction can also cause an acute swelling of the esophagus making it difficult to breathe and swallow.
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Reasons You May Be Having Difficulty Swallowing
Dr. Alexa Lessow at Lexington ENT & Allergy has treated numerous patients with dysphagia, the medical term for problems with swallowing. Sometimes determining the reason it hurts for you to swallow can be a complex undertaking, because it can be a symptom of quite a few different conditions.
In this post we discuss five of the most common reasons you may be having difficulty swallowing. If you have pain or discomfort when you swallow and cant determine why, seek treatment sooner rather than later. Early treatment can make a difference.
When Should I See An Allergist
An allergist is a healthcare provider specially trained to diagnose and treat people with allergies. They can help you figure out your triggers, discuss treatment options and help you avoid allergens. Talk to an allergist if you:
- Have allergy symptoms that are hard to control or manage.
- Have other medical conditions that make treating allergies more complicated.
- Need daily allergy medication.
- Need more tests to figure out what is causing your reactions.
- Think you may have had an anaphylactic reaction.
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What Tests Can Diagnose Anaphylaxis
An allergist may recommend testing your skin and blood. These tests can confirm the substances that cause severe reactions. A skin test places a small amount of the allergen on your skin to see if it causes a reaction. A blood test that measures tryptase can be helpful if obtained within one to three hours of the allergic reaction.
Confirming Or Ruling Out Eosinophilic Esophagitis
If you or your child fit the description above, our first order of business is to run some allergy tests to see whether you may be having a response to certain foods or other allergens. As well, we will likely arrange for an upper endoscopy, in which a camera and special instruments are inserted into your esophagus to take a closer look at the lining and to gather a tissue sample for biopsy.
If we find the presence of eosinophils in the biopsy and you or your child test positive for food allergies, the odds are were dealing with EoE.
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Pollen Allergy And Hay Fever
Hay fever, which is commonly referred to as a pollen allergy, is an allergic reaction to certain allergens, mostly grass pollen, and is referred to medically as allergic rhinitis.
Normally a healthy immune system does not acknowledge pollen in the air. However, in the case of a pollen allergy, these allergens irritate the mucous membranes.
This overreaction by the immune system often starts suddenly and can take place at different times of the year, depending on the flowering period of particular plants.
When To Seek Medical Help
Postnasal drip can be annoying, but it usually isn’t dangerous, as Harvard Medical School explains. However, there are some circumstances when you should seek medical help. See your doctor or dentist if your symptoms get worse or if they aren’t relieved by home remedies. You should also see your doctor if your sore throat is accompanied by other worrying symptoms, such as an unexplained fever or bloody mucus.
Allergy season has arrived, and while you may experience a sore throat from allergies, rest assured that there are many home remedies that can help to soothe your symptoms. If these home remedies aren’t enough, don’t hesitate to seek medical advice.
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What To Do If You Have Anaphylaxis
Give yourself epinephrine right away if you start to:
- have trouble breathing
- feel tightness in your throat
- have two or more milder allergic symptoms together
Don’t try to use an inhaler or antihistamine and wait to see what happens. Go straight for the epinephrine! Time matters during anaphylaxis.
If you have signs of a serious allergic reaction:
Difficulty Swallowing When Eating You May Have Eoe
Do you need to eat slowly and chew carefully to prevent food getting stuck? Do you have continuing heartburn or difficulty swallowing despite treatment with prescription strength proton pump inhibitors, such as omeprazole?
You may have a condition called eosinophilic esophagitis , a chronic allergic inflammation of the esophagus, which can lead to narrowing of the esophagus. Over the past 20 years, EoE has been increasingly recognized as the underlying cause in children presenting with feeding problems, vomiting or failure to gain weight and in adults presenting with difficulty swallowing and food impaction.
The allergic inflammation of EoE is triggered by food antigens. Airborne allergens are reported to play a role as well. The condition is more frequent in males and has a genetic component. Patients with EoE frequently have a personal or family history of environmental and food hypersensitivities, asthma, or eczema. Of note, the foods that tend to get stuck in the esophagus are typically dry, solid foods such as bread and meats, rather than the foods actually triggering the esophageal inflammation and ultimate narrowing.
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Spring Allergies May Make It Difficult To Swallow
Eosinophilic esophagitis is a disease characterized by the presence of a large number of eosinophils, a type of white blood cell, which causes inflammation in the esophagus. This inflammation can lead to stiffening or narrowing of the esophagus, which can lead to difficulty swallowing or food getting stuck in the esophagus. The cause in adults has not been clearly identified, but an allergic reaction to environmental and/or food allergens have been suggested in individuals who are genetically susceptible. There is a strong association with food allergies, environmental allergies, asthma, and atopic dermatitis. Hence the worsening of symptoms during Spring and Fall. This condition was initially thought to be rare, but has been increasing over the years, possibly due to increasing recognition. Current estimates of this condition may be as high as 2-3 per 10,000 individuals.
There are two basic approaches to treating eosinophilic esophagitis. One is to use medication , and the other is to change your diet. The most common dietary change is a six-food elimination diet, in which you remove milk, egg, soy, wheat, nuts/tree nuts, and fish/shellfish. A targeted-elimination diet can also be considered as well as referral to an allergist/immunologist. Currently treatment is directed at controlling symptoms, reducing eosinophil levels in the tissue, and preventing complications of the disease, such as food impactions.
How Allergies Can Cause A Sore Throat
The glands in your nose and throat make about one to two quarts of mucus every day, reports the American Academy of OtolaryngologyHead and Neck Surgery Foundation. This mucus has many important functions, such as keeping your nose clean and moistening the air you breathe, and you usually swallow it without realizing. Other times, people may notice mucus dripping down the back of their nose or pooling in their throat. This unpleasant sensation is known as postnasal drip, and it can be caused by allergies.
If you have postnasal drip, the trickle of mucus can irritate your throat and cause soreness and other symptoms, such as feeling a lump in the throat or swallowing more frequently. It may also make you feel the need to clear your throat more often.
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Why Might Eoe Be On The Rise
The exact reasons for the rise of EoE are unknown, and it is especially puzzling that in many cases EoE results from an allergic sensitivity to a food that has been well tolerated up to that point.
There are several hypotheses about why EoE is increasing. Many of them relate back to the idea that EoE, and other allergic and autoimmune diseases, seem to correlate with decreased exposure to microbes and infections. Possible explanations that have been explored include:
- The hygiene hypothesis: do fewer childhood infections equal more allergic diseases?
- Microbial dysbiosis: has the modern/Western diet and lifestyle changed our microbiome?
- Environmental factors: might changes in food production, genetic modification of crops, chemical additives, food processing, and pollutants play a role?
- Declining frequency of H. pylori infection: might this common stomach bacteria be protective against some allergic diseases?
- Increasing frequency of gastroesophageal reflux disease : could acid reflux break the barrier of the esophagus and allow food allergens to stimulate the immune system?
- Increasing use of acid-suppressing medications: does the use of antacids, especially early in life, change the microbes in the esophagus or somehow otherwise alter the risk of later food allergy?
What Is Drug Desensitization
Sometimes, you need to take a medication that youre allergic to. For example, certain chemotherapy medications to treat ovarian cancer may cause an allergic reaction. There may be no safe alternative.
A healthcare provider, usually an allergist or immunologist, can do drug desensitization. This helps your body temporarily accept the medicine. The provider gives you a very small dose of the medicine. Over a few hours, they gradually increase the dose until youve received the full amount. You continue to take the medicine regularly. Doing so keeps you in this temporary non-allergic state. Once you stop taking the medication, youll be allergic to it again.
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Allergens And Their Effects
Postnasal drip is the main culprit in cases of allergy-induced sore throat.
Its the result of exposure to an allergen and occurs when congestion in the nose and sinuses drains down to the throat. This causes tickling or scratchy pain.
The drainage also can cause:
Scratchiness is another way to determine if you have an allergy-induced sore throat.
In addition to the raw feeling that results from postnasal drainage, particles that directly enter the respiratory system can cause an itchy or scratchy feeling.
How Is Allergic Esophagitis Treated
Allergic esophagitis may not go away completely. Treatment may help relieve your symptoms.
- Steroid medicine may help decrease swelling in your esophagus. You will swallow the medicine so it coats your esophagus.
- Stomach acid medicine helps keep heartburn symptoms under control.
- Dilatation is a procedure used when the esophagus narrows from swelling. An endoscope is placed into your mouth and down your throat. Tools on the endoscope press against the tissues to widen your esophagus. Dilatation can improve your symptoms but will not stop allergic esophagitis from happening.
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Diagnosing Throat And Ear Pain
To diagnose the cause of your throat and ear pain, your provider might do a rapid strep test, a mono spot test, or a throat culture.
If these tests do not find the cause of your pain, you might need to have a computed tomography scan to look at your sinuses, allergy testing, or an endoscopy to look down your throat.
Your provider might also have you try medications that help with specific conditions, like acid reflux, to see if it makes your symptoms better.