Eosinophilic esophagitis: An allergy and immunology perspective on the updated guidelines.

Robert D Pesek, Emily C McGowan, Melanie A Ruffner, Benjamin L Wright, Jonathan M Spergel, Marc E Rothenberg, Evan S Dellon, Seema S Aceves

Journal: The Journal of allergy and clinical immunology 2025;156(2):252-258

PMID: 40339609

Full Text on Elsevier Science View on PubMed

Abstract

In January 2025, the American College of Gastroenterology published updated guidelines on the diagnosis and management of eosinophilic esophagitis (EoE). These new guidelines incorporated updated information on the pathophysiology, risk factors, natural history, and treatment of EoE. These guidelines were primarily intended for practicing gastroenterologists; therefore, we summarize their key recommendations for the allergy and immunology community. In addition, as the prevalence and health care burden of EoE continues to increase, the population affected primarily comprises allergic individuals, and less invasive monitoring techniques are on the horizon, we discuss the key means by which allergists can contribute to the diagnosis and management of EoE. In particular, allergists can participate in screening for subtle EoE symptoms among their allergy patients, assist in optimizing the management of other allergic comorbidities, provide education about elimination diets, and facilitate the monitoring of disease over time. Allergists are uniquely poised to treat the entire allergic individual, rather than just the allergic esophagus, and should be prepared to co-manage these patients along with gastroenterologists.

Address: Departments of Medicine and Pediatrics, Division of Allergy and Immunology, University of Virginia School of Medicine, Charlottesville, Va.; Department of Medicine, Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Phoenix, Ariz; Division of Allergy and Immunology, Phoenix Children's Hospital, Phoenix, Ariz.; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa; Department of Pediatrics, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa.; Department of Pediatrics, Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark.; Department of Pediatrics, Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati College of Medicine, Cincinnati, Ohio.; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa; Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa.; Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, and Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC.; Department of Pediatrics and Medicine, Division of Allergy, Immunology, University of California, San Diego and Rady Children's Health, San Diego, Calif. Electronic address: [email protected].

DOI: 10.1016/j.jaci.2025.04.026

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MeSH Terms: Humans, Eosinophilic Esophagitis, Practice Guidelines as Topic, Allergy and Immunology, Hypersensitivity