Hi doctor, I have had persistent nausea for roughly 15 months now which from memory started on a holiday where I had drank coffee and ended up with anxiety symptoms. I have had heaps of testing done and an endoscopy actually found eosinophilic esophagitis (which is basically esophagitis caused from an allergy). I have been treated with a PPI which appears to not be helping and have also been prescribed Lovan (Prozac). I am currently one week into taking these tablets and have recently cut out gluten and dairy to see if the allergy was from these foods. The doctor did a RAST test which showed a class 0 allergy to all main food groups including wheat and milk so I have just started eating them again. I have just drank my first coffee in about a week and had severe panic symptoms and tight throat which I have never experienced before. I would just like to know if a caffeine allergy is likely and could it be the cause of all these problems? I used to drink coffee fairly regularly and never quite felt great off it but it never seemed to make the nausea that much worse.
Hello. Thanks for writing your query to me.  After going through your history, it is very clear that what you described are totally two different issues. One thing is eosinophilic oesophagitis and second is caffeine sensitivity. I used the word sensitivity for caffeine because it is different from caffeine allergy. What you are suffering from now may be caffeine hypersensitivity as there are no other allergic symptoms associated with panic attacks. Even if you were having coffee before, you may become hypersensitive to coffee now.  The treatment of it is to avoid coffee at all and see the difference. Some oral Steroid spray like Flovent is also advised by gastroenterologists to prevent side effects of long term oral steroids. It is very difficult to differentiate between caffeine sensitivity and allergy based on clinical examination. For that you need to do skin prick test.  Finally avoidance is the best strategy for treating caffeine sensitivity. I hope the concept is clear to you now.