Consumer’s Guide to Biologics for Eosinophilic Esophagitis
Health ConditionsDigestive Health

The Consumer’s Guide to Biologics for Eosinophilic Esophagitis

Learn everything you need to know about the first FDA-approved treatment for eosinophilic esophagitis.
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Updated on March 27, 2025
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F or years, effective treatments for eosinophilic esophagitis (EoE), a condition that occurs when exposure to an allergen causes inflammation and swelling in the lining of the esophagus, were limited.

That started to change in spring 2022, when the U.S. Food and Drug Administration (FDA) approved the first medication specifically for treating EoE in adults and children over age 12: an injectable biologic known as dupilumab (Dupixent). In January 2024 approval was extended to children ages 1 to 11.

Other treatments for EoE followed. In February 2024, the FDA also approved the first oral therapy (referred to as a “swallowed topical steroid”), budesonide oral suspension (Eohilia), for adolescents and adults with EoE. The medication has been available in Canada and Europe for years. Other swallowed topical steroids have also been used off label, as have treatments such as proton pump inhibitors and dietary interventions.

If you’re living with EoE and unhappy with your current treatment, it may be worth talking to your doctor about your options. 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.

5 Essential Facts About Biologics for Eosinophilic Esophagitis

1. The FDA has approved only one biologic to treat EoE.

That drug, dupilumab, is sold under the brand name Dupixent. It is approved to treat EoE in adults and children who are at least a year old.

1. The FDA has approved only one biologic to treat EoE.

2. Other biologics are being studied for the treatment of EoE.

In time, dupilumab may no longer be the only biologic for EoE, as there are others in the works, says Brooks Cash, MD, chief of the division of gastroenterology, hepatology, and nutrition at the University of Texas Health Science Center in Houston.

Although several biologics have failed in clinical trials in recent years, a drug known as cendakimab is in development. Another, called mepolizumab, has shown inconsistent results, according to Dr. Cash.

2. Other biologics are being studied for the treatment of EoE.

3. Biologics are injectable medications.

Some biologics are given intravenously (through a needle into a vein) and some by infusion at a clinic or other setting. The biologic approved for EoE is self-administered subcutaneously, into the layer of fat just beneath the surface of the skin. That means you’ll inject the drug yourself, using an injector pen that comes prefilled with the prescribed dose, which is typically 300 milligrams.

3. Biologics are injectable medications.

4. Taking a biologic for EoE may help treat associated conditions.

Biologic drugs are approved to treat a wide range of chronic disorders, says Jonathan Spergel, MD, PhD, chief of the allergy program at Children’s Hospital of Philadelphia. Dupilumab is approved to treat other conditions, including asthma, atopic dermatitis (a type of eczema), and chronic rhinosinusitis, which are caused by the overzealous release of cytokines by the immune system.

What’s more, research shows people who have EoE are also more likely than the general population to have one or more additional immune system disorders, so taking a biologic for EoE may help relieve the symptoms of those conditions as well, says Cash.

Incidentally, the reverse may be true, too. Another study found that kids treated with dupilumab for asthma, atopic dermatitis, or nasal polyps also showed improvements in their EoE symptoms.

4. Taking a biologic for EoE may help treat associated conditions.

5. Biologics are considered safe but may cause minor side effects.

Biologics, unlike conventional medications, are created using living cells, rather than biochemicals, and have a solid track record for safety. They’ve been available in the United States for decades, and most people who take them have no serious problems, says Cash.

Even so, no medication is without side effects. In people with EoE who take dupilumab, the most common side effects include cold sores, joint pain, upper respiratory tract infections, and reactions around the injection site, such as itching, redness, and soreness.

5. Biologics are considered safe but may cause minor side effects.

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

Guidelines state that a biologic can be prescribed for people with severe EoE and for people with EoE and another allergic condition, such as allergic rhinitis, asthma, or atopic dermatitis, because it blocks IL-4 and IL-13, the cytokines that play a role in triggering allergic reactions, says Cash.

In other cases, a biologic may be used after other treatments, such as swallowed steroids and proton pump inhibitors, haven’t been effective, says Cash.

Along with medications, EoE sometimes is managed with an elimination diet, which involves removing common food allergens — usually dairy, eggs, soy, or wheat — from the diet and then adding them back in one at a time. This can help determine which, if any, trigger symptoms and should be avoided. But it should only be done under the guidance of a dietitian or gastroenterologist, not on your own.

“We have years of experience [treating eosinophilic esophagitis] with those therapies, and we know they can work,” says Cash.

Frequently Asked Questions

If you’re considering trying a biologic, you may be wondering what it’s like to take it on an ongoing basis. Speak to your doctor, who can offer you personalized input on these common concerns.

Making the Decision to Take a Biologic for Eosinophilic Esophagitis

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Congratulations!

You’ve learned how biologics work and how they treat EoE. Next step: Figure out if this type of drug may be right for you.
biologics-eoe-self-reflection-980x359

Self-Reflection

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

  1. Am I satisfied with my current treatment?
  2. Has my treatment improved my symptoms as much as I’d hoped?
  3. Am I satisfied with my elimination diet (if you follow one)?
  4. How would I rate my quality of life? Does EoE cause me to feel anxious or depressed? Does it interfere with my daily routine?
biologics-eoe-doctor-discussion-980x359

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 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?
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Additional Sources
  • Eosinophilic Esophagitis. National Organization for Rare Disorders. February 14, 2025.
  • Eosinophilic Esophagitis. American Academy of Allergy, Asthma & Immunology. May 1, 2023.
  • Press Release: Dupixent® FDA Approved as First and Only Treatment Indicated for Children Aged 1 Year and Older With Eosinophilic Esophagitis (EoE). Sanofi. January 25, 2024.
  • FDA Approves Takeda’s Eohilia (Budesonide Oral Suspension), the First and Only Oral Treatment in the U.S. for Eosinophilic Esophagitis (EoE). Takeda. February 12, 2024.
  • Nennstiel S et al. Treatment of Eosinophilic Esophagitis With Swallowed Topical Corticosteroids. World Journal of Gastroenterology. September 28, 2020.
  • Syverson EP et al. Update on Emerging Pharmacologic Therapies for Patients With Eosinophilic Esophagitis. Gastroenterology & Hepatology. April 2022.
  • Ayaki M et al. Prevalence of Autoimmune Disease in Patients With Eosinophilic Esophagitis: A Cross-Sectional Study of Three Hospitals in Japan. Internal Medicine. November 15, 2021.
  • Spergel BL et al. Improvement in Eosinophilic Esophagitis When Using Dupilumab for Other Indications or Compassionate Use. Annals of Allergy, Asthma & Immunology. May 2022.
  • Pricing and Insurance. Dupixent. January 2025.
  • Hirano I et al. Efficacy of Dupilumab in a Phase 2 Randomized Trial of Adults With Active Eosinophilic Esophagitis. Gastroenterology. January 2020.
  • Aceves SS et al. Clinical Guidance for the Use of Dupilumab in Eosinophilic Esophagitis. Annals of Allergy, Asthma & Immunology. March 2023.
  • Promising Results of Cendakimab to Treat EoE. American Partnership for Eosinophilic Disorders. November 1, 2024.
  • Dellon ES et al. Mepolizumab for Treatment of Adolescents and Adults With Eosinophilic Oesophagitis: a Multicentre, Randomised, Double-Blind, Placebo-Controlled Clinical Trial. Gut. October 2023.
  • Legrand F et al. Biologic Therapies Targeting Eosinophils: Current Status and Future Prospects. The Journal of Allergy and Clinical Immunology. March-April 2015.
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Yuying Luo, MD

Medical Reviewer

Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.

Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.

She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.

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Maria Masters

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Maria Masters is a contributing editor and writer for Everyday Health and What to Expect, and she has held positions at Men's Health and Family Circle. Her work has appeared in Health, on Prevention.com, on MensJournal.com, and in HGTV Magazine, among numerous other print and digital publications.

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