Can Eosinophilic Esophagitis Be the Reason Behind Your Chronic Cough?

Eosinophilic esophagitis (EoE) is a chronic immune system condition triggered by food allergies, which can cause a host of different symptoms. In some, unmanaged EoE can cause a cough.

A cough in someone who has EoE can happen for a couple reasons, says Ira Breite, MD , an associate professor at the Icahn School of Medicine at Mount Sinai in New York City.

"A lot of times when people with eosinophilic esophagitis are coughing, they are coughing more from their allergy or asthma," Dr. Breite says, adding that coughing can also be caused by acid reflux, which may occur in patients with EoE.

Symptoms

Coughing is a nonspecific symptom associated with many conditions or illnesses, so EoE should only be considered as a diagnosis if someone has other telltale symptoms, most notably difficulty swallowing food, a common occurrence in EoE called dysphagia , says Breite.

Other EoE symptoms include acid reflux, chest pain that does not respond to antacids, and regurgitation. All of these symptoms in a patient with EoE may cause someone to develop a cough.

As much as 15 percent of kids with EoE initially experience upper respiratory symptoms, including a cough, hoarseness, and choking.

Causes

A cough caused by EoE is typically ongoing, and usually occurs before the condition is diagnosed, says Russell Hopp, DO , a professor of pediatrics at the University of Nebraska Medical Center College of Medicine in Omaha.

The condition often occurs alongside other health conditions that are known to cause coughing, like gastroesophageal reflux disease (GERD) or asthma . If a person has one of these conditions as well, EoE is typically not a physician's first thought when making a diagnosis, says Hopp.

A persistent cough can also be the result of multiple allergy-related conditions, such as EoE and asthma. According to studies as much as 60 percent of children who have EoE also have asthma.

The condition is also more common in biological males.

"If they have swallowing trouble, with or without GERD, and they are male, and they have either asthma or allergies, EoE should be in the constellation of conditions considered," says Dr. Hopp, who is also a physician at the Food Hypersensitivity Clinic at Children's Nebraska.

In younger kids and toddlers, EoE cough may be dry and persistent.

Treatment

According to Hopp and Breite, the only way to treat an EoE cough is to treat the underlying condition. "Very immunologically complex food allergies are what triggers EoE," Hopp says.

Treatment starts with a diagnosis. This includes a history of symptoms along with an endoscopy - a procedure that guides a camera down the esophagus so a gastroenterologist can look for signs of EoE.

There isn't one single treatment for EoE. Most people require multiple interventions tailored to their allergies and triggers.

Elimination Diet

Since EoE is a type of allergic reaction, determining what foods a person is allergic to is usually the first step to treatment. This is usually done through an elimination diet . That involves removing a food from your diet for a few weeks and seeing if your symptoms improve, then adding it back in. If symptoms resume after you start eating that food again, that food is recognized as a trigger.

The most common EoE food triggers are:

• Milk
• Wheat
• Soy
• Eggs
• Nuts
• Seafood

However, "It's very uncommon that EoE is totally resolved with a food-only approach," Hopp says.

Medications

Many people will require medications. Many physicians prescribe proton pump inhibitors (PPIs) , a class of drugs used to relieve heartburn caused by acid reflux, which is common in people with EoE. However, many people don't experience an improvement in their EoE symptoms with PPIs.

If they do, improvement typically takes about a month. "It's not like you're going to take the pill and feel better right away. That happens with heartburn but not cough," Breite says, adding that if a person also has asthma, that may also need to be treated so an EoE cough goes away.

Other medications that may be used to treat EoE include steroids, which reduce inflammation in the esophagus, and monoclonal antibodies, which are part of a class of drugs called biologics . Monoclonal antibodies block immune-regulating proteins that have been shown to cause EoE.

Eosinophilic esophagitis is a chronic disease, meaning people usually need ongoing treatment. But the good news is, "Once it's managed, the cough is going to go away if it is caused by EoE," Hopp says.

The Takeaway

Eosinophilic esophagitis (EoE) is a chronic immune system condition triggered by food allergies that can sometimes cause a chronic cough. This cough may be due to other coexisting allergic conditions like asthma or gastroesophageal reflux disease (GERD). Treatment involves managing the underlying EoE through dietary changes and certain medications. Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy . We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

1. Eosinophilic esophagitis - Symptoms and causes. Mayo Clinic . September 21, 2022.
2. Rojas Pineda NA, Morfin Maciel BM, Chanona-Vilchis J. Throat clearing as the only symptom of eosinophilic esophagitis: A case report. Revista de Gastroenterología de México . 2020/04/01.
3. Comorbid Conditions of Eosinophilic Esophagitis. American Academy of Pediatrics . June 2023.
4. Shum V, Hopp R, Niebur H, et al. Chronic Cough as the Presenting Symptom of Eosinophilic Esophagitis. Allergies . 2021/9.
5. Gupta M et al. Diagnosis and Management of Eosinophilic Esophagitis. Canadian Medical Association Journal . February 2024.
6. Eosinophilic esophagitis, Diagnosis and Treatment. Mayo Clinic . September 2022.
7. Franciosi JP, Gordon M, Sinopoulou V, et al. Medical treatment of eosinophilic esophagitis. The Cochrane Database of Systematic Reviews . July 20, 2023.
8. Dellon ES, Rothenberg ME, Collins MH, et al. Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis. New England Journal of Medicine . December 22, 2022.

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Yuying Luo, MD

Medical Reviewer

Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.

Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women's gastrointestinal health.

She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.

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Kaitlin Sullivan

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Kaitlin Sullivan reports on health, science, and the environment from Colorado. She has a master's in health and science journalism from the City University of New York. See full bio See Our Editorial Policy Meet Our Health Expert Network