Eosinophilic esophagitis (EoE) is an emerging allergic disorder predominantly triggered by food allergens. Several dietary interventions have been evaluated in adults so far. Based on amino acid-based formulas, elemental diet is the most effective, but is also impractical, whereas elimination diet based on skin testing has shown suboptimal cure rates (26%-36%). An empiric six-food group elimination diet (SFGED), prospectively evaluated in unicenter studies, has achieved remission in over 70% EoE patients. Still, the majority (65%-85%) of SFGED responders have just one or two causative foods identified after six food-group challenges and endoscopies, so some dietary restrictions and subsequent endoscopies after food challenge may be unnecessary.

Now, in a study recently published in The Journal of Allergy and Clinical Immunology, Javier Molina-Infante and colleagues present the results of the first prospective multicenter study on empiric elimination diet for EoE, evaluating a simplified four-food group elimination diet (FFGED) (dairy products, wheat, egg and legumes) for adult EoE.

The efficacy of this six week FFGED was evaluated in 52 consecutive patients from four Spanish hospitals. In those unresponsive to FFGED, a rescue SFGED was proposed. Among patients responsive to a FFGED, 78% completed the individual food reintroduction process.

The study shows 54% of adult EoE patients achieve clinico histological remission on an empiric FFGED; in addition, almost a third of non-responders to FFGED could be effectively rescued with a SFGED, coming to an overall effectiveness of 72%. Therefore, 3 out of every 4 adult patients achieving remission on a SFGED may achieve it on a FFGED, a less restrictive dietary intervention that requires fewer endoscopies and shortens the food reintroduction process. After food reintroduction, all FFGED responders had just 1 or 2 food triggers identified. The most common food triggers were cow´s milk (50%), egg  (36%) and wheat  (31%), with milk being the only causative food in 27% of adult patients. Results were consistent among the four participating centers.

This study underscores the general applicability of dietary interventions for adult EoE in clinical practice. This multistage, empiric, dietary approach (FFGED followed by SFGED) may be recommended to simplify dietary management for EoE patients, since a FFGED is a simpler, cheaper and less inconvenient initial dietary intervention to screen a majority of EoE patients with one or two food triggers.
(from AAAAI.org website) For more info on eosinophilic esophagitis, click here

Dr. Kenneth Backman of Allergy & Asthma Care of Fairfield County comments: “Eosinophilic esophagitis is a relatively newly identified disorder about which we continue to learn more. Food elimination diets have clearly been very effective in children, but in adults results have been mixed. This study demonstrates that food elimination diets can be quite helpful in adults, even while making them easier by reducing the number of foods avoided. Due to the difficulty in eliminating even this smaller number of foods, many adults choose to pursue swallowed “inhaled” steroids, which are highly effective.”