These data is consistent with our earlier reported that IL-18 in vitro alone capable to generates and even transforms naïve IL-5-generated eosinophils into pathogenic eosinophils17 suggests that IL-18 is critical and may explain why EoE is not effectively treated with anti-IL-5 (mepolizumab) or anti-IL-13 therapy. This evidence concerns the gene IL13 and eosinophilic esophagitis.