Compared to symptoms like difficulty swallowing, reflux, and abdominal pain, cough is less recognized as a common symptom of eosinophilic esophagitis (EoE). However, a chronic cough can be an early sign of EoE in some children, and it may be a frustrating symptom that can affect quality of life for your child or you.

What Causes Cough in Eosinophilic Esophagitis?

In people with EoE, some parts of the immune system are overactive. White blood cells called eosinophils gather in the esophagus, the tube through which food enters the stomach. Eosinophils release chemicals that cause coughing and chronic inflammation that irritates the throat and leads to trouble swallowing. Children with EoE may refuse to eat, or food may get stuck in their throats. Known as food impaction, this may become a medical emergency.

Other causes of chronic cough include asthma, acid reflux, and postnasal drip, which should be ruled out in people with EoE and chronic cough. Consult a doctor if a cough lasts longer than eight weeks in an adult or four weeks in a child. Your doctor can help identify what’s causing the cough or making it worse — whether that’s EoE or another condition — and recommend appropriate treatments.

Read on for ways to manage coughing related to EoE.

1. Identify and Avoid Triggers

Identifying and avoiding triggers may help reduce chronic coughing and other symptoms of EoE. Most people with EoE have one or more allergic conditions, such as:

• Food allergies
• Asthma
• Allergic rhinitis (seasonal allergies or hay fever)
• Atopic dermatitis (the most common form of eczema)

For most people with EoE, symptoms are related to food allergies. For others, environmental allergens such as dust mites, pollen, and animal dander may make EoE symptoms worse.

If you’ve been diagnosed with EoE, allergy testing is an important step toward feeling better. An allergist may use different types of tests to identify your allergens (substances you have allergic reactions to) and recommend treatment.

Elimination Diets

Your allergist may recommend a food-elimination diet to treat EoE and relieve cough and other symptoms. For instance, they may suggest you make dietary changes like avoiding shellfish or tree nuts. If you avoid specific food allergens, your cough and other EoE symptoms may improve.

In other cases, your doctor may suggest trying an elemental diet. With this strict type of elimination diet, you eat only an amino acid formula or perhaps one or two foods deemed safe.

2. Talk to Your Doctor About Prescription Medication

Several types of medication may help control inflammation caused by EoE. Currently, the U.S. Food and Drug Administration (FDA) has approved two drugs to treat EoE:

• Dupilumab (Dupixent) is injected once a week and is indicated for people 12 years or older who weigh at least 88 pounds.
• Budesonide (Eohilia oral suspension), a corticosteroid (sometimes simply called a steroid), can be taken orally in the form of a thick liquid by people aged 11 and up.

Other drugs that are sometimes used to reduce inflammation and manage EoE symptoms include proton pump inhibitors and fluticasone (a different steroid), taken orally. People with associated asthma may benefit from inhaled corticosteroids and drugs that open the airways. Talk to your or your child’s EoE doctor if you’re interested in learning more about the potential benefits and side effects of prescription medications to control inflammation.

Read about ways treatment options are improving for people with EoE.

3. Drink Plenty of Water

It’s important to drink lots of water throughout the day. Staying hydrated can help ease both chronic throat inflammation and chronic cough.

4. Gargle With Warm Salt Water

Gargling with warm salt water a few times a day may soothe a sore throat and help relieve coughing. Stir about half a teaspoon of table salt into a glass of warm water, gargle with the solution, and then spit it out (don’t swallow it).

5. Avoid Cigarette Smoke

Smoking is a common cause of chronic coughing. If you or your child has EoE, quit smoking to avoid this risk factor for yourself or to limit your child’s exposure to secondhand smoke.

6. Get Advice About Over-the-Counter Medications

It may be tempting to take over-the-counter (OTC) medications like ibuprofen to calm throat irritation and perhaps soothe a cough. However, it’s best to get advice from your health care provider before taking any OTC painkillers.

Some drugs, including the popular OTC painkillers aspirin and acetaminophen (sold under brand names including Tylenol), have been linked to gastritis (inflammation of the stomach lining) and esophagitis (inflammation of the esophagus). Researchers believe this may be related to taking the medications with too little water, so the pills scratch or burn the delicate lining of the esophagus. If you have EoE, be sure to always take oral medications with plenty of water to avoid further damage and irritation to your throat.

Talk With Others Who Understand

On myEoEcenter, the site for people with eosinophilic esophagitis and their loved ones, people come together to learn about EoE and share their stories with others who understand life with the condition.

Do you or your child have EoE and a chronic cough? Have you found helpful ways to reduce this symptom? Share your experience in the comments below.