Objective:

To report a case of eosinophilic esophagitis (EoE) in a child with severe IgE-mediated cow’s milk allergy and asthma during ongoing omalizumab treatment, highlighting the complexities involved.

Key Findings:

• The patient had a history of IgE-mediated cow’s milk allergy and severe asthma.
• While on omalizumab, the patient tolerated less processed dairy products for several months.
• He subsequently developed recurrent vomiting and anaphylaxis after consuming ice cream.
• Upper endoscopy confirmed esophageal inflammation and histological diagnosis of EoE.
• Treatment with proton pump inhibitors and topical budesonide led to clinical improvement.

Interpretation:

The case highlights the need to consider EoE in highly atopic patients who develop persistent gastrointestinal symptoms during dietary liberalization, emphasizing the importance of monitoring.

Limitations:

• Causal inferences regarding the relationship between omalizumab treatment and EoE cannot be made.
• The case is based on a single patient experience, necessitating further research.

Conclusion:

This case illustrates the complexity of managing atopic conditions and the potential emergence of EoE during dietary changes in patients with severe allergies, underscoring the need for a multidisciplinary approach.