The Consumer’s Guide to Biologics for Eosinophilic Esophagitis

Everything you need to know about the first FDA-approved treatment for eosinophilic esophagitis.

I n May 2022, the U.S. Food and Drug Administration (FDA) approved the use of the biologic medication dupilumab (Dupixent) to treat eosinophilic esophagitis (EoE).

Dupilumab is not only the first biologic drug for EoE, but also the first drug of any class to be approved to treat the condition — an immune system disorder in which exposure to an allergen causes inflammation and swelling in the lining of the esophagus.

With one biologic in the EoE arsenal, several others may be on the way. If you’re living with EoE and not happy with your current treatment, it may be worth talking to your doctor about trying a biologic. To make that conversation as productive as possible, it can help to first learn all you can about biologics and how they help treat EoE.

How Biologics Treat EoE

5 Essential Facts About Biologics for Eosinophilic Esophagitis

When Is It Time to Try a Biologic for Eosinophilic Esophagitis?

There are no established guidelines for when a biologic like dupilumab should be prescribed for eosinophilic esophagitis (EoE), but it’s usually reserved for when first-line treatments aren’t working. In the case of EoE, these are typically proton pump inhibitors (PPIs) and corticosteroids, both prescribed for off-label use for EoE.

Along with medication, EoE sometimes is managed with an elimination diet, which involves removing common food allergens — typically, dairy, eggs, soy, and wheat — from the diet and then adding them back in one at a time to determine which, if any, trigger symptoms and should be avoided.

“We have years of experience [treating eosinophilic esophagitis] with those therapies, and we know they can work,” says Cash. “Just because [dupilumab] is the only FDA-approved therapy doesn’t mean that it moves straight to the top of the line.”

That said, if you have another allergic condition, such as asthma or atopic dermatitis, you may be a good candidate for dupilumab, says Cash, since it blocks IL-4 and IL-13, the cytokines that play a role in triggering allergic reactions.

6 FAQs About Taking a Biologic for Eosinophilic Esophagitis

If you’re considering trying a biologic, you’re likely wondering what taking it on an ongoing basis will be like. When you speak to your doctor, they can offer you personalized input on these common concerns.

Making the Decision to Take a Biologic for Eosinophilic Esophagitis



You’ve learned how biologics work and how they treat EoE. Next step: Figure out if this type of drug might be right for you.



Before your next doctor’s appointment, ask yourself these key questions:

  1. Are you satisfied with your current treatment?
  2. Has it improved your symptoms as much as you’d hoped?
  3. If you follow an elimination diet, are you satisfied with it?
  4. How would you rate your quality of life? For example, does EoE cause you to feel anxious or depressed? Does it interfere with your daily routine?


Doctor Discussion

If you’ve recently been diagnosed with eosinophilic esophagitis or aren’t satisfied with your current treatment, you may want to consider taking a biologic. Here are a few questions you can bring with you to your next doctor’s appointment. Use them to help you guide the conversation and learn whether this medication may be right for you.

  1. Am I a good candidate for a biologic?
  2. What can I expect by taking this medication?
  3. How long will the medication take to work?
  4. What type of symptom relief can I expect?
  5. How long will I need to take a biologic?
  6. Are there any medications, supplements, or preexisting conditions that can interfere with this treatment?
  7. What else should I know before I try a biologic?