Eosinophilic esophagitis: An allergy and immunology perspective on the updated guidelines

Abstract

In January 2025, the American College of Gastroenterology published updated guidelines on the diagnosis and management of eosinophilic esophagitis (EoE). These new guidelines incorporated updated information on the pathophysiology, risk factors, natural history, and treatment of EoE. These guidelines were primarily intended for practicing gastroenterologists; therefore, we summarize their key recommendations for the allergy and immunology community. In addition, as the prevalence and health care burden of EoE continues to increase, the population affected primarily comprises allergic individuals, and less invasive monitoring techniques are on the horizon, we discuss the key means by which allergists can contribute to the diagnosis and management of EoE. In particular, allergists can participate in screening for subtle EoE symptoms among their allergy patients, assist in optimizing the management of other allergic comorbidities, provide education about elimination diets, and facilitate the monitoring of disease over time. Allergists are uniquely poised to treat the entire allergic individual, rather than just the allergic esophagus, and should be prepared to co-manage these patients along with gastroenterologists.

Keywords: Eosinophilic esophagitis; allergy; fibrosis; guidelines; inflammatory; skin testing.