Eosinophilic Oesophagitis in the Atopic March: A Multidisciplinary Strategy for Atopic Diseases EOS Network recognises the urgent need for a more holistic approach to treating patients with Eosinophilic-Associated Diseases (EADs). Many of these patients also have atopic diseases and immediate allergies, conditions driven by a common mechanism, Type 2 (T2) inflammation. Despite the high risk of coexisting T2 diseases, these conditions are still treated separately. This fragmented approach leads to multiple treatments, sometimes the same or similar drugs, are prescribed for different but related conditions (polypharmacy). As a result, patients experience a higher treatment burden and a reduced health-related quality of life (hrQoL). A recent review published in Frontiers highlights the need for early Eosinophilic Oesophagitis (EoE) screening in atopic patients. Biologic therapies, such as Dupilumab, target the underlying T2 inflammation that drives multiple related conditions. This review advocates for a multidisciplinary “umbrella” treatment approach, where a single biologic agent could be used to manage EoE alongside other atopic diseases, reducing the need for multiple treatments and improving patient outcomes. EoE and Its Connection to Other T2 Inflammatory Diseases Shared immunopathologic mechanisms of the atopic march, Frontiers EoE is a chronic T2 inflammatory disease characterised by eosinophilic infiltration of the oesophagus, leading to symptoms like dysphagia and food impaction. Recently, EoE has been recognised as a part of the “atopic march,” a progression of atopic diseases that often begins in childhood and continues into adulthood. This group of diseases includes other atopic diseases, such as Bronchial Asthma (BA), Allergic Rhinitis (AR), Atopic Dermatitis (AD), and food allergies (FA). Until recently, there were no alternative treatments for these diseases when standard ones failed. This often forces patients to rely on steroids for extended periods, which can cause significant side effects. However, new biologic therapies like dupilumab target shared T2 inflammatory pathways and treat multiple conditions, including EoE, with one treatment. This strategy can potentially lower costs, improve treatment adherence, and enhance patients' quality of life. Independent Treatment vs. a Multidisciplinary Approach Dupilumab as an “umbrella” to treat multiple co-existing diseases, Frontiers EoE often remains unrecognised and underdiagnosed, especially when the symptoms mimic gastroesophageal reflux disease (GERD). EoE patients have a 2.8 to 5.1 times higher risk of developing other T2 diseases. However, these conditions are still treated separately, leading to multiple prescriptions from different specialists and increased medication use (polypharmacy). Immunologists and dermatologists must be able to recognise “red flags” for EoE and investigate its presence, as treatment options remain limited, unlike those for BA, AD, and chronic rhinosinusitis with nasal polyps (CRSwNP). The presence of associated EoE might favour dupilumab over other biologic agents, thus avoiding polypharmacy and its related drawbacks. This review aims to raise awareness among specialists about screening for EoE when red flags appear, encouraging a multidisciplinary approach to managing T2 diseases with a single biologic treatment. Biological drugs approved for other T2 diseases and also investigated in EoE, Frontiers Study Conclusion The study highlights the effectiveness of dupilumab in managing each of the T2 conditions belonging to the “atopic march.” Therefore, it is reasonable to hypothesise that dupilumab might be used as a single therapy across multiple indications in the same patient. Amanda Cordell, CEO&Founder, EOS Network Around 80% of our Eosinophilic patient community has one or more atopic diseases, and many also observe them among family members. EOS Network recognises these needs and advocates for a holistic approach to diagnosing and managing Type 2 inflammatory conditions that not only addresses individual conditions but also considers the broader impact on patients and their families. Given the high prevalence of EoE in atopic patients, early screening and multidisciplinary collaboration are essential. This review emphasises the need for greater awareness among specialists to screen for EoE early and adopt an “umbrella” treatment strategy. As new biologic treatments become available, it is essential to consider personalised medicine and the holistic value of these treatments. By reducing polypharmacy, this approach can improve outcomes for patients with coexisting atopic conditions. Reference Lutzu N, Favale A, Demurtas M, Del Giacco S, Onali S and Fantini MC (2025) Eosinophilic esophagitis in the “atopic march”: dupilumab as an “umbrella” strategy for multiple coexisting atopic diseases. Front. Med. 11:1513417. doi: 10.3389/fmed.2024.1513417 Read the full publication Read similar publications: Improving Care In Eosinophilic Diseases: A Charter The Evolving Understanding of Eosinophilic-Associated Type 2 Inflammatory Diseases Access to Dupixent (Dupilumab) Treatment in the UK Explained Understanding the Link Between Food Allergy and Atopic Dermatitis. Key Study Insights IL-10-Producing B Cells Reduce Atopic Dermatitis by Limiting Eosinophil Activity EU Approves Dupixent® (dupilumab) as First Treatment for Young Children with EoE Manage Cookie Preferences