WATSONTOWN - When Tyler Cotner was an infant, he developed a rash on his face.
His parents, Brian and Tina, did not know what to make of it or what to do.
They sought medical help, but medications didn't seem to work.
The Cotner family, of Watsontown, is dealing with a case of eosinophilic esophagitis that is affecting 7-year-old Tyler, second from right. Also shown, from left, are mother Tina, daughter Sarah and father Brian.
Ointments seemed to clean up the rash, but then Tyler had vomiting spells.
"He couldn't eat anything without vomiting," recalled his mother.
The rashes and the vomiting were a red flag, according to Dr. Allison Freeman, director of allergy and immunology at Geisinger Medical Center in Danville.
It was thought Tyler might be suffering from eosinophilic esophagitis, an allergic inflammatory condition of the esophagus.
A followup biopsy of the esophagus showed an increase in the number of allergy cells.
"It means the body is fighting an allergen," Freeman said.
Among the treatments for eosinophilic esophagitis is dietary modification.
But first, it needed to be determined what foods were triggering the disease.
"With Tyler, we did tests. We found a number of foods that he was allergic to," Freeman said. "He actually got positive tests to more than a dozen foods."
Those foods were eliminated from his diet.
In the meantime, Tyler was taken off foods and given a formula diet.
Over the next five years, he continued to be tested while being put back on one to three food items at a time.
"We start that process with the foods that tested lowest. In Tyler's case it was vegetables and fruits," she said.
Now, Tyler is much improved and can eat many different foods.
Peanuts, tree nuts and fish are among the foods he still can't eat.
"Those things he will probably need to avoid for the rest of his life," Freeman added.
There's little question that Tyler's diet has expanded.
His mother said he eats cheese and other dairy products as well as soy and wheat products, vegetables, and pork and turkey.
Freeman said eosinophilic esophagitis has a genetic component and it is not uncommon for members of the same family to have the condition and to come to her for treatment.
"There are probably some other factors. We believe there are probably some other environmental factors," she said.
The condition occurs in adults as well as children.
Tyler's case, Freeman said, has been one of the more extreme cases she's seen.
But the good news is, it now can be controlled.
He takes acid reflux medicine, which helps protect his esophagus, said his mother.
But he has to be very careful about what he eats.
"Everytime we go somewhere, he takes his own food," his father said.
A first-grade student at Watsontown Elementary School, Tyler always packs his lunch.
Through it all, the boy has not been fazed.
"He's been great about it," Tina said.
Freeman said constant monitoring of food intake is the key.
She said family support and communication among medical professionals, including a dietitian, can be the key to successful treatment.
"One of the reasons Tyler is doing well is he has a very attentive mother," Freeman added.
Seven of 10 people with the condition have other types of allergies.
"Over time, he (Tyler) has developed nasal allergies. That is something we typically see," she said.