RECOMMENDATION ABSTRACT : Food allergy and eosinophilic esophagitis

Successful Food Elimination Therapy in Adult Eosinophilic Esophagitis: Not All Patients are the Same.

González-Cervera J,

J Clin Gastroenterol. 2012 Feb 13

Departments of Allergy †Gastroenterology, Hospital General de Tomelloso, Tomelloso ‡Research Unit, Complejo Hospitalario La Mancha Centro, Alcázar de San Juan §Department of Pathology, Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain.

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated, esophageal disease characterized by esophageal dysfunction and eosinophilic inflammation, manifested mainly as dysphagia and frequent food impaction. EoE is recognized into the spectrum of food allergy, but food sensitization studies used not to be efficient to identify the triggering food, because of what patients are frequently treated with topic steroids or even endoscopic esophageal dilation. Herein, we describe 3 adult patients-all suffering from EoE, but with different sensitization patterns-who were treated successfully with elimination diets. Allergy tests indicated no food sensitization for patient 1, but challenge with milk and wheat were positive. Food IgE-mediated allergies were found in patients 2 and 3; inflammation was resolved with food elimination. Lack of food allergy sensitization does not exclude the possibility of food allergies as a cause of EoE; elimination diets must therefore be considered as an effective diagnostic and treatment tool.

Identification of specific foods responsible for inflammation in children with eosinophilic esophagitis successfully treated with empiric elimination diet.

Kagalwalla AF

J Pediatr Gastroenterol Nutr. 2011 Aug;53(2):145-9.

Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

OBJECTIVES: Eosinophilic esophagitis (EoE) is an immune-mediated chronic inflammatory disorder triggered by food antigen(s). A 6-food elimination diet (SFED) excluding cow’s milk, soy, wheat, egg, peanuts/tree nuts, and seafood has been shown to induce remission in a majority of children with EoE. The goal of the present study was to identify specific food antigens responsible for eosinophilic esophageal inflammation in children with EoE who had achieved histological remission with the SFED.

PATIENTS AND METHODS: In this analysis, we retrospectively analyzed children with EoE who completed subsequent single-food reintroductions that led to identification of foods causing disease recurrence. Repeat upper endoscopy with biopsies was performed after single-food introductions. Recurrence of esophageal eosinophilia following a food reintroduction identified that food antigen as a cause of EoE.

RESULTS: A total of 36/46  (25 M/11F) children who were initially successfully treated with SFED completed this trial; the mean age was 7.6  ±  4.3 years. The most common foods identified were 25 to cow’s milk (74%), 8 to wheat (26%), 4 to eggs (17%), 3 to soy (10%), and 1 to peanut (6%). Milk was 8 times more likely to cause EoE compared with wheat, the next most common food (95% confidence interval 2.41-26.62, P = 0.0007).

CONCLUSIONS: Serial single-food reintroductions following induction of histological remission with the SFED can lead to the identification of specific causal food antigen(s) in EoE. Cow’s milk was the most common food identified in subjects with EoE treated with SFED. A subset of children with EoE may develop tolerance to their food sensitivities while on the SFED.

Food allergy and eosinophilic esophagitis.

Chehade M, et al.

Curr Opin Allergy Clin Immunol. 2010 Jun;10(3):231-7.

Division of Allergy/immunology, Department of Pediatrics, Mount Sinai Center for Eosinophilic Disorders, Mount Sinai School of Medicine, New York, NY 10029, USA.

PURPOSE OF REVIEW: Eosinophilic esophagitis (EoE) is a chronic allergic disease of the esophagus. A mix of immediate, IgE-mediated and delayed, non-IgE-mediated immunological reactions to foods is thought to play a role in EoE. Our purpose is to review available clinical and research evidence for this link between food allergy and EoE.

RECENT FINDINGS: Various food elimination trials resulted in various rates of disease remission. Exclusive amino acid formula-based dietary trials resulted in more than 90% remission in children with EoE. Empiric elimination diets consisting of avoidance of foods commonly known to cause hypersensitivity reactions resulted in 50-74% disease remission. When diets were tailored based on results from skin prick and atopy patch tests, remission rates were comparable. Translational research studies performed on esophageal tissues and peripheral blood of patients with EoE demonstrated an allergic T-helper type 2 phenotype, though mechanisms linking the disease to food allergens are not fully addressed.

SUMMARY: Foods appear to be important allergic triggers in EoE. Identification of these triggers, however, remains a challenge. Research is needed to elucidate at which point in the pathogenesis of EoE foods become important so that their role can be better understood, and develop better tests to identify these foods.

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Clinical and Editor in Chief :

Dr Widodo Judarwanto, pediatrician email :, Curiculum Vitae

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