Rare but probably often non-diagnosed. Esophageal chronic disease of allergic origin. Seems more common among boys. The pathophysiology is unknown but appears to involve a combination of immediate allergy (IgE) and delayed allergy to some food (egg, peanut, soya) or airborne allergens (pollen, mites). Children less than 4 years old are more often allergic to a food while older children and adolescents are more often allergic to airborne allergens.

Diagnosis: symptoms of esophageal dysfunction + histological picture of predominantly eosinophilic inflammation.

Symptoms: pain upon swallowing, food refusal, dysphagia (sometimes food blockage), which do not respond to anti-reflux treatment or antacids; growth retardation.

Endoscopy: macroscopically normal in 30 % of cases; sometimes "train rails" picture.

Treatment: avoidance of the identified allergen, corticosteroid therapy or dupilumab (monoclonal antibody directed against the IL4 alpha receptor, which blocks the IL4 and IL13 pathways) subcutaneously every 4 weeks

Anesthetic implications:

other signs of atopy (dermatitis, asthma, allergic rhinitis); corticosteroid therapy. There no contraindication to the use of propofol.

References : 

-        Chadha SN, Li W, Correa H, Moulton D, Hummell DS. 
Pediatric eosinophilic esophagitis : the Vanderbilt experience. 
Ann Allergy Asthma Immunol 2014; 113: 445-51.

-        Metha P, Sundaram S, Furuta GT et al.
Propofol use in pediatric patients with food allergy and esosinophilic esophagitis.
J Pediatr Gastroenterol Nutr 2017; 64: 546-9.

-        Fernandez PG, Mikhael M.
Perioperative considerations for the food-allergic pediatric patient.
Pediatr Anesth 2017; 27: 461-70.

-        Dewachter P, Kopac P, Laguna JJ, Mertes PM et al.
Anaesthetic management of patients with pre-existing allergic conditions: a narrative review.
Br J Anaesth 2019; 123 (1): e65-81.

-        Chehade M, Dellon ES, Spergel JM, et al.
Dupilumab for Eosinophilic Esophagitis in patients 1 to 11 years of age.
NEJM 2024;390 :2239-51

Updated: August 2024