If you have eosinophilic esophagitis (EoE), you may avoid social situations that involve food. But talking about the condition and proper planning can help you stay socially active.
EoE is an immune condition that affects your esophagus, the tube that connects the throat to the stomach. Food allergies, seasonal allergies, and acid reflux can all trigger EoE.
During an attack, the immune system overreacts. This causes white blood cells called eosinophils to build up in the esophagus.
The esophagus becomes inflamed, resulting in choking, trouble swallowing, and food impaction (when food gets stuck in the esophagus). Over time, you can develop a narrowing of the passageway.
There’s currently no cure for EoE. The main treatments are dietary changes and medications that help reduce inflammation.
Recent research has shed light on the mental health impacts of EoE. They stem from food anxiety and wanting to hide the condition. As a result, people may experience social anxiety or avoid social situations, primarily those that involve food.
If you live with EoE, some strategies may help support your mental health. These can help you engage with others in social and professional settings without worrying about experiencing EoE symptoms.
EoE can lead to many symptoms that give rise to concerns around eating. People may experience:
- difficulty swallowing (dysphagia)
- food stuck in the esophagus
- stomach pain
- weight loss
- lack of appetite
EoE is a chronic, lifelong condition. Treatment such as dietary changes and medication can help manage the symptoms of EoE. For many people, staying healthy involves avoiding foods that may cause a reaction.
Though there is currently no cure for EOE, treatment can involve:
- Elimination diet: A doctor may recommend removing certain foods from your diet. These may include the foods most associated with the EoE allergic response: shellfish, tree nuts, peanuts, dairy, soy, egg, and wheat.
- Elemental diet: All major foods are removed and a person receives nutrition from a special amino acid formula.
- Medication: A doctor prescribes drugs to reduce inflammation of the esophagus. Options include proton pump inhibitors, which reduce stomach acid, and dupilumab (Dupixent), a biologic that targets specific proteins that trigger inflammation in the esophagus. Steroids that are either swallowed or taken through an asthma inhaler can also help reduce inflammation.
- Esophageal dilation: The esophagus can become very narrow as a result of EoE and cause food to become impacted. Dilation is a procedure to stretch out the narrow part of the esophagus with a balloon or tube.
The feelings that come with an EoE diagnosis are often complicated and may include fear of swallowing and avoidance of eating in public settings.
Other mental health impacts of EoE included:
- internalized and perceived stigma around EoE
- fear of medication side effects
- worry about food preparation and availability
- social embarrassment
- worry about choking in public
- wanting to hide an EoE attack from others
These impacts crossed the personal and professional spheres — people experienced challenges dining out and participating in work interviews.
If you live with EoE, you may be able to take steps to manage it that can help support your mental health and reduce barriers to spending time with others socially and professionally.
Talk about it
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This may seem contradictory when so many perceive stigma with EoE. However, confiding in friends and family may be a source of support. It may also make it easier if you have people on your side when planning gatherings that involve food.
Call restaurants beforehand
Before you attend a work lunch or social occasion, contact the restaurant. Let them know about your dietary restrictions so you can make choices during your meal.
Consider a chef card that lists specific food allergies. You can present this at the restaurant to the manager or server. Food Allergy Research & Education (FARE) has a chef card template you can customize to foods that trigger an EoE attack.
Ask for water and take it slow
People with EoE often
Pack your own food
If you’re traveling or visiting friends, consider packing your own food. This can help ensure what you eat probably won’t trigger your EoE symptoms. If you’re on an elemental diet, be sure to have enough of the nutritional supplement to last your entire time away.
Bringing your food to a friend’s home or to a party may make you feel uncomfortable. Consider speaking with your friend or the host before you arrive and telling them about EoE. You can explain why you’re bringing your own food, and they may be able to help accommodate you by having food or drinks on hand that won’t cause an attack.
Plan social events that don’t revolve around food
Reach out to others and suggest get-togethers that revolve around activities instead of eating. You can go to a play, a concert, or spend a day in the park. Even if grabbing a bite to eat may seem inevitable in many situations, it can be easier to control what you eat if the main event doesn’t involve food.
Join a support group
Speaking with people who live with EoE can be an excellent way to support your mental health and connect with others.
Consider online groups such as the EoE Eosinophilic Esophagitis Adult Group on Facebook. The American Partnership for Eosinophilic Disorders (APFED) has a monitored online community called EOS Connections for people with eosinophilic conditions. APFED also has a directory of volunteer-led in-person groups in local communities across the United States.
Eosinophilic esophagitis (EoE) is a chronic immune disorder. It can be managed with diet changes and medication but can often lead to feelings of stigma, anxiety over eating, and depression. You can help manage the mental health impact of EoE by taking proactive steps to make eating and socializing with others safe and enjoyable.