Patient is 37-year-old female who comes in today with complaints of trouble swallowing and severe heartburn that she had almost all of her life. In August, she was eating an apple and the apple got stuck in her throat. She was then sent to St. Luke’s and they did an endoscopy to try to remove the apple and pursued a biopsy as well as attempted dilation at that time. They further diagnosed eosinophilic esophagitis at this time and were unable to dilate due to the skin of the esophagus being so viable and irritated. We have then put her on omeprazole 40 mg daily at that time. She has not previously been tested for food allergies in the past, but has other than to shellfish that she has avoided since high school and has an allergy to Lobster, crab, and shrimp. She also has noticed that her symptoms get worse and she swells up when she eats whey protein. Other than the whey protein and shellfish, she does not have angioedema and tongue throat swelling, but she does get irritations and causing severe heartburn and trouble swallowing occasionally in the past. She has therefore eliminated most foods in the nightshade family including potato, pear, strawberry, etc. and this has given her some relief. She has also eliminated milk products as well and this gives her relief as well.
Before the time of the apple in August other than heartburn problem, she has been fairly symptom-free and it is hard for her to determine what type of medical treatment she would like to pursue due to not being symptomatic at this time.
She denies any history of seasonal allergies. She has never had any problems mainly with sneezing, postnasal drip, or nasal stuffiness. She does occasionally get sore throat. She does not see any seasonal variation with her allergies, although sometimes when she is in pine trees a lot she may get slight allergy symptoms, but these did not bother her. She has had a sinus infection in the past, but no chronic sinus infection or long-term use of antibiotics needed. She denies any nasal polyps, frequent headaches, aspirin-induced nasal symptoms, frequent bad cold, and frequent tonsillitis. She denies any problems with frequent ear infections or any dizziness, lightheadedness, or hearing impairment. She also denies any eye symptoms of itching, redness, tearing, dryness, or burning or eyelid swelling or eyelid irritation. She also denies any history of wheezing or lung problems and not been diagnosed with asthma in the past or needed any inhaler for infections or exercise-induced. She has not had any allergic skin problems including atopic dermatitis or eczema as a child or currently she has never been tested for allergies before.
1. Eosinophilic esophagitis.
2. Shellfish allergy.
3. Concern for food allergies.
1. We will prescribe EpiPen for her shellfish allergy as well as whey protein and potentially egg causing problems with throat swelling.
2. She already avoids milk products and will continue to avoid milk products to help reduced symptoms of eosinophilic esophagitis.
3. Restart Prevacid. She was given a prescription of this in August, but stopped to annoyingly as to what it was helping. I encouraged her to begin the PPI again just to see if her eosinophilic esophagitis is responsive to PPI regimen at 40 mg.
4. We discussed other options to help reduce her eosinophilic esophagitis symptoms. She does not complain of any symptoms on a normal basis, so she would like to minimize medication use at this time, although the apple incident with food stuck did concern her. We discussed possibility of using Flovent or Pulmicort Respules and she is worry to have specific localized corticosteroid in her esophagus for prophylaxis and presenting recurrence of throat or things getting stuck in her throat.
5. We also did a celiac panel for laboratory studies to rule out any celiac disease for her.
6. We will follow up in four weeks’ time to see how the PPI is treating her as well as go over celiac panel results and further treatment courses for her eosinophilic esophagitis.