Asthma and Eosinophilic Esophagitis: What’s the Connection?

Medically reviewed by Todd Eisner, M.D.
Written by Emily Wagner, M.S.
Posted on October 7, 2022


  • 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.

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.

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.

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.

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.

Corticosteroids

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.

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.

    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.

    Posted on October 7, 2022

    Patti3

    I have suffered from asthma for years. It seemed to get worse when I was a custodian, exposed to different chemicals and lots of dust. Triggers include cold air, humid air, and allergens like smoke, dust or mold. I just cleaned out a closet and now I'm having lots of symptoms. It even happens when I wear a mask. I take Singulair and use sn inhaler occasionally. I tried Advair but didn't like it.

    posted February 26, 2023
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    How Did I Develop Eosinophilic Asthma
    May 9, 2024 by Elaine2
    Todd Eisner, M.D. has 32 years of experience in gastroenterology and internal medicine. Review provided by VeriMed Healthcare Network. Learn more about him here.
    Emily Wagner, M.S. holds a Master of Science in biomedical sciences with a focus in pharmacology. She is passionate about immunology, cancer biology, and molecular biology. Learn more about her here.

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