Asthma and Eosinophilic Esophagitis: What’s the Connection? | myEoEcenter (2023)

Asthma and Eosinophilic Esophagitis: What’s the Connection? | myEoEcenter (1)

Asthma and Eosinophilic Esophagitis: What’s the Connection? | myEoEcenter (2)

  • Asthma and eosinophilic esophagitis (EoE) are both inflammatory conditions that involve eosinophils, a type of immune cell associated with allergic reactions.
  • People with related conditions such as seasonal allergies, eczema, or EoE are at a higher risk of developing asthma or other immune-related diseases.
  • Asthma and EoE involve similar types of inflammation and are treated with some of the same medications and dietary changes.

Asthma and Eosinophilic Esophagitis: What’s the Connection? | myEoEcenter (3)

Eosinophilic esophagitis is an inflammatory immune-related condition that affects the esophagus — the tube food travels down when swallowed. Asthma is a chronic immune-related disease in which the lining of your airways becomes inflamed after coming into contact with allergens — substances that can cause allergic responses like pollen, dust, and pet dander. Oftentimes, people with one immune disorder are more likely to develop other related conditions.

In particular, people with EoE are at a higher risk of developing conditions including asthma, food allergies, allergic rhinitis (seasonal allergies), and atopic dermatitis (eczema). As many as 75 percent of people living with EoE either have one of these conditions themselves or a family history of them.

Many studies have noted the similarities between asthma and EoE, including their relation to the immune system and how they’re treated. In fact, some health experts call EoE “asthma of the esophagus” due to the overlap between the conditions. Understanding the similarities and connections between asthma and EoE is important for receiving a correct diagnosis and appropriate treatment.

(Video) Novel Insights in Eosinophilic Asthma

Understanding Atopy and Eosinophils

The word “atopy” refers to “the genetic tendency to develop allergic diseases such as allergic rhinitis, asthma, and atopic dermatitis,” according to The American Academy of Allergy Asthma & Immunology. Conditions like asthma, EoE, and seasonal allergies are all atopic.

Asthma and EoE tend to occur together, often alongside other atopic conditions. Specifically, studies show that anywhere from 12 percent to 68 percent of people worldwide living with EoE have a history of asthma. While there appears to be a connection between the two conditions, few studies outline exactly why this is. Researchers have some theories, including the overlap in immune system function and the involvement of eosinophils.

Asthma and Eosinophilic Esophagitis: What’s the Connection? | myEoEcenter (4)

Inflammation Is an Immune System Reaction

Both asthma and EoE are immune-related conditions with chronic inflammation caused by exposure to allergens. Both conditions involve inflammation of the mucosa, the membranes that line the nasal passages and esophagus.

Asthma and EoE both involve an immune process known as a helper T cell type 2 (or TH2) immune response — a specific type of inflammation that sends signals to eosinophils. The eosinophils then move to the lungs (in the case of asthma) or the esophagus (in EoE) and cause more inflammation, eventually leading to the development of symptoms.

People with chronic or severe asthma tend to have high levels of eosinophils in their airways, sputum (mucus from the respiratory tract), and bloodstream. The higher these levels are, the more severe the asthma is. Similarly, EoE is defined by an elevated number of eosinophils in the esophageal tissues and bloodstream.

(Video) What is Eosinophilic Esophagitis? | Family Allergy and Asthma

Genetic Components of Asthma and Eosinophilic Esophagitis

Researchers believe both asthma and EoE have genetic components, but no current studies directly tie variations in specific genes to the conditions. Scientists believe EoE may be caused by changes in the eotaxin-3 gene, which promotes the movement of eosinophils into sites of inflammation. Studies also show that the calpain-14 gene may interfere with the cells that line the esophagus. On the other hand, scientists believe asthma is caused by a number of gene variations — not just one or two.

What Is Eosinophilic Asthma?

Eosinophilic asthma is a specific subtype of asthma that is caused by an increase in eosinophils in the lung tissue, blood, and sputum. The eosinophils drive inflammation in the lungs and respiratory tract, which becomes thickened. This can make breathing difficult.

Most cases of eosinophilic asthma are diagnosed in adults ages 35 to 50, but it can also develop in children and older adults. Oftentimes, people with asthma are also sensitive to other allergens. However, in the case of eosinophilic asthma, most people don’t have other allergies. The condition affects people equally, regardless of sex. Eosinophilic asthma tends to be more severe and may not respond as well to traditional asthma treatments as other subtypes.

Treatments for Asthma and Eosinophilic Esophagitis

Treatments for asthma and EoE overlap quite a bit because they are focused on reducing inflammation caused by eosinophils. In fact, some medications that are used for treating asthma — particularly eosinophilic asthma — are also used for treating EoE. These include corticosteroids and biologic medications. Specific dietary changes can also reduce inflammation associated with both conditions.

Asthma and Eosinophilic Esophagitis: What’s the Connection? | myEoEcenter (5)


Both asthma and EoE can be treated with topical steroids (also known as corticosteroids) inhaled to help reduce inflammation in the airways and esophagus, respectively. Steroids used for treating EoE include fluticasone propionate (Flovent), via an inhaler, and an oral formulation of budesonide called Entocort EC, which can be mixed into a slurry — for example, combined with a sweetener like syrup or honey — and swallowed.

(Video) Eosinophilic Esophagitis

Asthma is also treated using fluticasone and budesonide, which come in a few different formulations depending on the dosing and whether they’re being used as a prevention or maintenance treatment. These include:

  • Fluticasone propionate (Flovent and ArmonAir)
  • Fluticasone furoate (Arnuity and Ellipta)
  • Budesonide (Pulmicor)

    Biologic Medications

    Biologic medications can also be used to treat asthma and EoE. Biologics are synthetic versions of immune proteins called antibodies. Each antibody targets a specific part of the immune system to dampen inflammation at its source. The U.S. Food and Drug Administration (FDA) has approved the biologic Dupixent — a formulation of dupilumab — to treat EoE and moderate to severe eosinophilic asthma.

    The FDA approved Dupixent specifically as an additional maintenance treatment for eosinophilic asthma in pediatric and adult cases. People with moderate to severe asthma cases may be unresponsive to inhaled corticosteroids and may need oral corticosteroids for treating their condition.

    Dietary Changes

    People with food allergies have to be careful to avoid their allergy triggers in order to limit unwanted symptoms. EoE and asthma are both associated with food allergies, which can be managed by avoiding eating certain foods.

    People with asthma may react to preservatives if they’re present in foods in large amounts. This includes sulfites, a type of preservative found in pickles, wine, and dried fruits. Limiting these foods may help control asthma symptoms. Having both asthma and a food allergy can make an allergic reaction worse than having allergies alone.

    For people with EoE, food allergies may make symptoms worse. In fact, many people with EoE tend to have allergies to wheat and cow’s milk. Narrowing down which food is causing EoE symptoms to flare can be difficult, as the allergic response to the allergen may be delayed for days. Doctors therefore recommend trying an elimination diet. This involves avoiding common causes of food allergies — such as dairy, wheat, soy, eggs, tree nuts, fish, and shellfish — and then taking note of when symptoms disappear. You would then add the food allergens back into your diet one at a time to see which ones cause symptoms.

    (Video) Dupilumab for Eosinophilic Esophagitis | NEJM

    Asthma and Eosinophilic Esophagitis: What’s the Connection? | myEoEcenter (6)

    Talk With Your Doctor About Your Symptoms

    If you’re experiencing symptoms of EoE or asthma, be sure to talk to your doctor. Telling them about what you’re experiencing is the first step to receiving an accurate diagnosis and the treatment you need. If you have any other underlying health conditions, which may or may not be related to EoE, let your doctor know. This is especially true when visiting a new health care provider on your first visit.

    If your doctor suspects you have EoE or another related condition, they may refer you to specialists — such as a gastroenterologist or an allergist — to help diagnose and treat your condition. These specialists may perform certain tests, including allergy testing and an upper endoscopy, to confirm a diagnosis of EoE or to determine another related condition.

    Find Your Team

    On myEoEcenter, the site for people with eosinophilic esophagitis and their loved ones, people come together to gain a new understanding of EoE and share their stories with others who understand life with EoE.

    Have you experienced asthma along with your EoE? Share your experiences in the comments below.


    1. Eosinophilic Esophagitis — MedlinePlus
    2. Atopy Defined — American Academy of Allergy Asthma & Immunology
    3. Eosinophilic Esophagitis — Johns Hopkins Medicine
    4. Eosinophilic Esophagitis — Allergy, Asthma & Clinical Immunology
    5. Eosinophilic Esophagitis: An Important Co-Morbid Condition of Asthma? — Clinical Reviews in Allergy and Immunology
    6. Eosinophilic Esophagitis: Asthma of the Esophagus? — Digestive Diseases
    7. Asthma Defined — American Academy of Allergy Asthma & Immunology
    8. Allergens and Allergic Asthma — Asthma and Allergy Foundation of America
    9. Diagnosis and Management of Eosinophilic Asthma: a US Perspective — Journal of Asthma and Allergy
    10. Eosinophilic Esophagitis — Mayo Clinic
    11. Genome-Wide Association Studies in Asthma — Current Opinion in Allergy and Clinical Immunology
    12. Eosinophilic Asthma — American Partnership for Eosinophilic Disorders
    13. Inhaled Corticosteroids — American Academy of Allergy Asthma & Immunology
    14. FDA Approves First Treatment for Eosinophilic Esophagitis — U.S. Food and Drug Administration
    15. Asthma Medicines and Treatment — Asthma and Allergy Foundation of America
    16. Food Can Affect Asthma — Asthma and Allergy Foundation of America
    17. Asthma Diet: Does What You Eat Make a Difference? — Mayo Clinic
    18. The Role of Food Allergy in Eosinophilic Esophagitis — Journal of Asthma and Allergy
    19. Eosinophilic Esophagitis — American Academy of Allergy Asthma and Immunology


    Can eosinophilic esophagitis cause breathing problems? ›

    Eosinophilic esophagitis can cause food impaction and difficulty breathing. These symptoms are medical emergencies and require immediate care. Living with the thought of not being able to swallow or breathe is very frightening.

    How does asthma cause eosinophilia? ›

    Two different pathways lead to eosinophilic airway inflammation in asthma. In allergic asthma, dendritic cells present allergens to CD4+ T-cells, inducing T-helper (Th)2 cells, which produce interleukin (IL)-4, IL-5 and IL-13, and leading to IgE switching in B-cells, airway eosinophilia and mucous hypersecretion.

    What is the most common cause of eosinophilic esophagitis? ›

    Causes. EoE is caused by an allergic reaction to certain foods or environmental allergens.

    What diseases are associated with eosinophilic esophagitis? ›

    Allergies and asthma.

    If you have food or environmental allergies, asthma, atopic dermatitis, or a chronic respiratory disease, you're more likely to be diagnosed with eosinophilic esophagitis.

    Can you have EoE and asthma? ›

    EoE is frequently associated with asthma, and up to 80% of patients with EoE are atopic, similar to childhood asthma. Adult-onset asthma is not necessarily associated with atopy (termed intrinsic asthma) and similar observations have been made for EoE.

    What is eosinophilic asthma? ›

    Eosinophilic asthma is a type of asthma that is caused by high levels of white blood cells called eosinophils in the airways of the lungs. The purpose of these white blood cells is to help you fight infections. Sometimes these immune cells are over-reactive and cause inflammation in the body, including in the lungs.

    How do you know if asthma is eosinophilic? ›

    A patient's sputum sample is examined under a microscope. To get the sample of sputum for testing, a patient coughs up a mucus sample. This procedure is non-invasive and may be performed in a doctor's office. Having more than 2-3% of cells being eosinophilic in the sputum suggests eosinophilic asthma.

    How do you get rid of eosinophilic asthma? ›

    Eosinophils love to team up with leukotrienes and cause inflammation in your upper and lower airways. Medicines called leukotriene modifiers -- such as montelukast (Singulair), zafirlukast (Accolate), and zileuton (Zyflo) -- relieve the effects of leukotrienes and ease asthma symptoms.

    What level of eosinophils indicate asthma? ›

    Conclusions: Blood eosinophil counts ≥ 200 cells/µL are associated with asthma exacerbation. Blood eosinophil count is a modifiable factor that could be addressed in asthma management strategies.

    How I cured my eosinophilic esophagitis? ›

    There is no cure for EoE. Treatments can manage your symptoms and prevent further damage. The two main types of treatments are medicines and diet.

    What foods to avoid if you have eosinophilic esophagitis? ›

    The six-food elimination diet (SFED) is the most frequently employed dietary therapy in patients with EoE. This diet typically trials the exclusion of wheat, milk, egg, nuts, soy, fish and shellfish.

    How do people live with eosinophilic esophagitis? ›

    Living with eosinophilic esophagitis

    You will need to manage it for the rest of your life. This includes staying away from the foods or allergens that cause your allergic reaction. In many cases, you will need to stay on medicines. It's important to work closely with your gastroenterologist.

    Is eosinophilic esophagitis the same as asthma? ›

    Asthma is the most common chronic disease of the airways in childhood. Eosinophilic esophagitis is a chronic inflammatory disorder characterized by eosinophilia in esophageal mucosa that causes feeding difficulties, regurgitation, vomiting, abdominal pain, dysphagia, and food impaction.

    Can eosinophilic esophagitis affect the lungs? ›

    Perhaps because it is an allergic disease, EOE is sometimes called 'oesophageal asthma'. While it's possible to have both EOE and asthma together, they are separate diseases affecting different parts of the body – EOE affects the esophagus and asthma affects the lungs.

    What foods heal esophagitis? ›

    Use high protein, thick liquids and higher calorie items, such as milkshakes, custard, pudding, macaroni and cheese, etc. Some other soft or liquid-‐type foods are applesauce, cooked cereals, strained cream soup, mashed potatoes, Jello, rice pudding, etc.

    Are eosinophils always raised in asthma? ›

    Asthma is commonly associated with peripheral blood eosinophilia. However, markedly increased levels are not common in allergic asthma and a high index of suspicion for another cause is required especially if patients do not respond to inhaled corticosteroid therapy.

    Does asthma increase eosinophil count? ›

    Eosinophils are increased as a feature of persistent inflammation, which in turn has been associated with an increased number of asthma attacks and the decline of lung function. However, the relationship between eosinophilic inflammation and airflow obstruction and hyper-responsiveness is not yet well understood.

    Is eosinophilic asthma a disability? ›

    Yes. In both the ADA and Section 504, a person with a disability is someone who has a physical or mental impairment that seriously limits one or more major life activities, or who is regarded as having such impairments. Asthma and allergies are usually considered disabilities under the ADA.

    What doctor treats eosinophilic asthma? ›

    Pulmonologists focus on conditions that affect your respiratory tract, which stretches from your nose to your windpipe to the lungs. If you've been diagnosed with eosinophilic asthma, especially if your case is severe, you'll likely need a pulmonologist to put together a personal treatment plan.

    What is the new medication for eosinophilic asthma? ›

    FASENRA is an add-on maintenance treatment for patients 12 and older with severe eosinophilic asthma. See more. Not for other eosinophilic conditions or sudden breathing problems. FASENRA is an add-on maintenance treatment for patients 12 and older with severe eosinophilic asthma.

    Does Albuterol help with eosinophils? ›

    Albuterol treatment significantly increased the LAR compared to placebo treatment (p = 0.003) and significantly enhanced the number of sputum eosinophils (p = 0.009) and sputum ECP (p = 0.04) at 7 h but not 24 h post-allergen (p > 0.05).

    Does albuterol help eosinophilic asthma? ›

    Treatment strategies

    For patients who require additional treatment, systemic corticosteroids or biologic agents targeted toward eosinophils may be needed.” Bronchodilators such as albuterol are usually not effective as single-agent therapy because they do not address the underlying eosinophilic inflammation.

    What foods reduce eosinophils? ›

    Eat a healthy diet free of acidic foods: Both acid reflux and heartburn can raise your body's eosinophil count. To avoid these conditions, one must eat a balanced, healthy diet. Look for low-fat foods, including lean meats, whole grains, fresh fruits and vegetables, and whole-grain foods.

    Is coffee good for eosinophils? ›

    In group 5 the caffeine increased the number of neutrophils 2.7-times and increased the number of eosinophils 4.6-times (P < 0.05) compared with control. Our study revealed that caffeine played an important role in the development of protective immune response.

    What happens if you don't treat eosinophilic esophagitis? ›

    In most cases, EoE develops as an allergic response to certain foods including wheat, milk, egg, soy, nuts, and seafood. If it is not properly diagnosed and treated, EoE may lead to permanent scarring or strictures (narrowing of the esophagus).

    What is a natural remedy for eosinophilic esophagitis? ›

    Natural treatments may help control the symptoms, but they won't cure eosinophilic esophagitis. Some herbal remedies such as licorice and chamomile may help acid reflux symptoms. Acupuncture and relaxation techniques like meditation can also help prevent reflux.

    Does eosinophilic esophagitis ever go away? ›

    People with EoE may also be treated with oral or liquid steroids to decrease inflammation or with an immunomodulating medication. Many patients respond to these approaches within 6 to 8 weeks, their symptoms resolve, and they have no problem eating solid foods.

    Are you born with eosinophilic esophagitis? ›

    Children are probably not born with EoE but develop it over time. They may be born with a predisposition to the disorder.

    What vitamin is deficient in EoE? ›

    When the researchers examined a cohort of patients with EoE, they found that many of these patients had a vitamin D deficiency, Rothenberg said. Biopsies revealed that the severity of their disease, including eosinophil levels, histological changes and other features, were inversely proportional to vitamin D levels.

    How rare is eosinophilic esophagitis? ›

    Eosinophilic esophagitis is a rare disease, but increasing in prevalence with an estimated 1 out of 2,000 people affected.

    What is esophageal asthma? ›

    The disorder is sometimes referred to as “asthma of the esophagus” given that it shares many clinical and pathophysiologic characteristics with asthma [1]. Eosinophils are typically present throughout the gastrointestinal tract since it is continuously exposed to foods, environmental allergens, toxins, and pathogens.

    What is the best drink for esophagitis? ›

    Drinking water, low fat milk, and herbal teas may help manage it. Alcohol, caffeinated drinks, and sodas may worsen symptoms, however. Acid reflux, or heartburn, occurs when stomach acid flows up into a person's esophagus, or food pipe. It is common for people to experience acid reflux intermittently.

    What vitamin helps esophagitis? ›

    B vitamins

    In fact, one study found that increased intake of several B vitamins was associated with a lower risk of reflux esophagitis, a condition characterized by inflammation in the esophagus often caused by acid reflux ( 8 ).

    What juice is good for esophagitis? ›

    carrot juice. aloe vera juice. cabbage juice. freshly juiced drinks made with less acidic foods, such as beets, watermelon, spinach, cucumber, or pear.

    Can eosinophils cause shortness of breath? ›

    Symptoms of chronic EP develop more slowly, sometimes months before a provider diagnoses eosinophilic pneumonia. People with CEP rarely develop respiratory failure or low blood oxygen levels. Common symptoms include: Shortness of breath that worsens.

    Can esophagitis affect your breathing? ›

    Studies show that stomach acid can inflame the windpipe, which affects breathing. However, esophageal acidity can also trigger the vagus nerve which tells the lungs to tighten (bronchoconstriction), and this can cause GERD wheezing.

    Can an inflamed esophagus cause breathing problems? ›

    Shortness of breath, also called dyspnea, occurs with GERD because stomach acid that creeps into the esophagus can enter the lungs, particularly during sleep, and cause swelling of the airways. This can lead to asthma reactions or cause aspiration pneumonia.

    Is eosinophilic asthma life threatening? ›

    The disease can even be fatal. Thanks to new treatment options, this does not have to be the case. However, people with eosinophilic asthma must stick to their treatment plan and practice self-care to keep themselves in the best health possible.

    Are eosinophilic esophagitis and eosinophilic asthma related? ›

    [1,2] Eosinophilic esophagitis (EoE), a relatively new clinico-pathologic disorder, is often associated with allergic diseases such as asthma, allergic rhinitis and atopic dermatitis (AD). Both asthma and EoE are often characterized immunologically by T helper 2 (TH2) responses and allergic sensitizations.

    Does esophagitis affect the heart? ›

    The lower esophageal inflammation (esophagitis) can lead to AF and other heart dysrhythmias.

    Does your esophagus have anything to do with your breathing? ›

    However, they have two very different functions. Your trachea is part of your respiratory system, and your esophagus is part of your digestive system. Your trachea transports air in and out of your lungs, whereas your esophagus transports food and liquid from your throat to your stomach.

    Can asthma cause esophagus problems? ›

    Some experts believe that asthma also may trigger GERD, when breathing difficulties or certain asthma medications cause the esophageal sphincter muscle to relax and allow stomach contents to reflux — completing a troublesome, potential vicious cycle.

    Can inflamed esophagus cause wheezing? ›

    GERD can cause asthma-like symptoms via two mechanisms: Aspiration of acid particles in the trachea can cause coughing, wheezing and pneumonia. Acid in the esophagus causes a reflex phenomenon in the trachea, triggering asthma-like symptoms.


    1. The Latest on New Options for Eosinophilic Esophagitis: Considering Targeted Biologic Therapy
    (PeerView CME)
    2. Role of allergy in EoE: what's the connection? Part 1
    (EOS Network)
    3. What’s new for eosinophilic oesophagitis? A case-based discussion of patient care
    (Touch Medical Media Services)
    4. Eosinophilic Asthma Medications and Management
    5. Eosinophilic esophagitis (EoE): Approaching from all angles
    (UCLA Health)
    6. The Type 2 Inflammation Connection – Jori, eosinophilic esophagitis (EOE)
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