Dietary therapy for eosinophilic esophagitis

Publication date: Available online 6 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Javier Molina-Infante, Alfredo J. Lucendo
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated, esophageal disease triggered predominantly, but not excusively, by food antigens. Presently, available food allergy tests are suboptimal to predict food triggers for EoE, especially in adults. Elemental diet (exclusive feeding with aminoacid-based formulas) and empiric six-food elimination diet (6-FED; withdrawing milk, wheat, egg, soy, nuts and fish/seafood for 6 weeks), have consistently shown the best efficacy rates. However, their high level of restriction and need for multiple endoscopies have hampered their implementation in clinical practice. Currently, milk, wheat/gluten and egg are the most common food triggers in children and adults from US, Spain and Australia. Hence, less restrictive empiric schemes, like a four-food (4-FED; dairy, gluten-containing cereals, egg, and legumes) or a two-food (2-FED; dairy and gluten-containing cereals) have been lately developed with good efficacy rates (2-FED 43%; 4-FED adults 54%, children 64%). A step-up approach (2-4-6) may result in prompt recognition of a majority of responders with few food triggers, reducing the number of endoscopies and costs, and shortening the diagnostic process. Standardization of food reintroduction, novel food allergy testing and studies evaluating milk elimination diet in children and the long-term outcomes of dietary interventions are warranted.



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