The mystery of my burning esophagus

It wasn’t until I called Brendan Canning, a professor of medicine at Johns Hopkins, that I found someone willing to speculate about how an allergy in the esophagus could cause the terrifying sensation of drowning. Canning, a self-described “science nerd,” is not a doctor but a researcher who focuses on allergies and the respiratory tract. He explained to me that the nerves that transmit pain, shortness of breath, and other information from our organs lead, like telegraph lines, to very primitive parts of the brain that are physically close to each other. Because of this proximity, neurons receiving signals sometimes have difficulty determining precisely where the message is coming from. It could be that any irritation in the esophagus, whether from a rising surge of acid or inflammation caused by a food allergy, could be interpreted as originating in the lungs – or even the heart – and a body could respond, as it apparently does. He made mine, With the panic of someone drowning. “It’s not surprising that this could happen,” Canning said, given “the tremendous overlap that exists in the brainstem.”

Because there Has there been no successful program to conquer allergic diseases? Eosinophilic esophagitis is rare, but allergic diseases as a group include the itchy skin of eczema, the hives and vomiting of food allergies, the runny nose of hay fever season, the breathing problems of allergic asthma, and further. They affect nearly one in three Americans, making life miserable for large sectors of the population. And if the microbiome has been implicated for so long in these ailments (and now EoE), why is it taking so long for microbiome-targeted therapy to become available? “We wonder about that too,” Alkis Togias, chief of the Division of Allergy, Asthma and Respiratory Biology at the National Institute of Allergy and Infectious Diseases, told me. In recent years, the institute has submitted only a few applications for microbiome-related studies, he says, far fewer than anticipated. He suspects that scientists are not convinced they have identified the right microbes. But Togias says the agency is taking the allergy problem seriously and that funding for the study of food allergies, for example, has increased from $1.3 million in 2003 to between $60 million and $80 million. year. ” he says. “But I totally agree with you. It should be more.”

Much of the science on the microbiome suggests that what you encounter early in life sets the tone for how your immune system will function later, so it’s understandable that many in the field focus on prevention, rather than how to fix an already dysfunctional community of microbes. But some researchers have been pursuing the possibility of changing those adult microbiomes as well.

A few years ago, Rima Rachid, director of the Allergen Immunotherapy Program at Boston Children’s Hospital, and her colleagues gave microbes from nonallergic donors to 10 adult volunteers with peanut allergies. Subjects ingested, in capsule form, carefully examined feces from healthy people to see if the microbes they contained could alleviate their nut allergies. After four months, three subjects were able to tolerate at least three times the amount of peanut protein compared to the amounts that originally triggered the reaction. That translated into a little more than a peanut. Three out of five patients who, before swallowing the capsules, took antibiotics, presumably clearing their own distorted microbiomes and facilitating the establishment of new ones, were able to tolerate more than two protein peanuts.

The study was small, lacked a control group, and was inconclusive. (A follow-up study with children is underway.) And EoE doesn’t work exactly like these more common nut allergies. But the research gives people like me, adults with an established allergic disease, reason to have hope. “I don’t think you can say that once the microbiome forms, all hope is lost,” Rachid told me. “There is an opportunity to change the microbiome.”

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