Journal Article
. 2005 Nov; 95(4):336-43.
doi: 10.1016/S1081-1206(10)61151-9.

Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests

Jonathan M Spergel 1 Timothy Andrews  Terri F Brown-Whitehorn  Janet L Beausoleil  Chris A Liacouras  
  • PMID: 16279563
  •     135 citations


Background: Eosinophilic esophagitis (EE) is a recently described disorder identified in patients with symptoms suggestive of gastroesophageal reflux disease (GERD) but unresponsive to conventional reflux therapies. Therapies have included corticosteroids, elemental diet, and diet restriction. We report our experience with skin prick and atopy patch testing and food elimination diets in patients diagnosed as having EE.

Objective: To identify food antigens that cause EE and the characteristics of patients who respond to food elimination vs those who are unresponsive.

Methods: Patients diagnosed as having EE had restricted diets based on skin prick and atopy patch testing results. Additional biopsies were performed after 4 to 8 weeks of restricted diet. Demographics, atopic tendencies, and food antigens were identified retrospectively in our food allergy database.

Results: A total of 146 patients diagnosed as having EE were evaluated with skin prick and atopy patch testing. Thirty-nine patients had unequivocal demonstration of food causing EE, with normalization of biopsy results on elimination and reoccurrence on reintroduction. An additional 73 patients, for a total 112 (77%) of 146 patients, had resolution of their EE as demonstrated by biopsy results. Fifteen (10%) of 146 patients were nonresponders manifested by no significant reduction in esophageal eosinophils despite restricted diet based on skin prick and atopy patch testing. Egg, milk, and soy were identified most frequently with skin prick testing, whereas corn, soy, and wheat were identified most frequently with atopy patch testing.

Conclusion: In more than 75% of patients with EE, both symptoms and esophageal inflammation can be significantly improved with dietary elimination of foods. Skin prick and atopy patch testing can help identify foods in most patients.

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Pediatr Gastroenterol Hepatol Nutr, 2020 Jan 29; 23(1). PMID: 31988878    Free PMC article.
Poor Relationship Between Fractionated Exhaled Nitric Oxide and Disease Activity in Eosinophilic Esophagitis.
Kimberly Johnson, Vivek Iyer, +5 authors, Jeffrey Alexander.
Dysphagia, 2018 Jul 26; 34(1). PMID: 30043082
Pediatric eosinophilic esophagitis: updates for the primary care setting.
Melanie A Ruffner, Jonathan M Spergel.
Curr Opin Pediatr, 2018 Sep 22; 30(6). PMID: 30239371    Free PMC article.
Eosinophilic esophagitis in pediatric age, state of the art and review of the literature.
Silvia Iuliano, Roberta Minelli, +7 authors, Gian Luigi De'Angelis.
Acta Biomed, 2018 Dec 19; 89(8-S). PMID: 30561413    Free PMC article.
Illuminating Elimination Diets: Controversies Regarding Dietary Treatment of Eosinophilic Esophagitis.
Cary C Cotton, Raquel Durban, Evan S Dellon.
Dig Dis Sci, 2019 Mar 31; 64(6). PMID: 30927211    Free PMC article.
Correction to: Eosinophilic esophagitis.
Stuart Carr, Edmond S Chan, Wade Watson.
Allergy Asthma Clin Immunol, 2019 Apr 23; 15. PMID: 31007687    Free PMC article.
Significance of Interleukin (IL)-15 in IgE associated eosinophilic Esophagitis (EoE).
Sathisha Upparahalli Venkateshaiah, Hemanth Kumar Kandikattu, Anil Mishra.
Int J Basic Clin Immunol, 2020 Apr 17; 2. PMID: 32296783    Free PMC article.
Non-surgical interventions for eosinophilic esophagitis.
Elizabeth J Elliott, Diana Thomas, Jonathan E Markowitz.
Cochrane Database Syst Rev, 2010 Mar 20; (3). PMID: 20238328    Free PMC article.
Systematic Review.
Clinical Presentation and Approach to Dietary Management of Eosinophilic Esophagitis.
Nirmala Gonsalves.
Gastroenterol Hepatol (N Y), 2019 Feb 26; 14(12). PMID: 30804717    Free PMC article.
Liberalized Versus Strict Cow's Milk Elimination for the Treatment of Children with Eosinophilic Esophagitis.
Timothy Teoh, Christopher Mill, +2 authors, Vishal Avinashi.
J Can Assoc Gastroenterol, 2019 Jul 12; 2(2). PMID: 31294369    Free PMC article.
Signals from the various immune cells in promoting food allergy-induced eosinophilic esophagitis like disease.
Priscilia Lianto, Yani Zhang, Huilian Che.
Asia Pac Allergy, 2019 Aug 07; 9(3). PMID: 31384583    Free PMC article.
Eosinophilic Esophagitis as a Side Effect of Food Oral Immunotherapy.
Antonella Cianferoni.
Medicina (Kaunas), 2020 Nov 20; 56(11). PMID: 33207848    Free PMC article.
Cow's Milk Allergy: Immunomodulation by Dietary Intervention.
Enza D'Auria, Silvia Salvatore, +7 authors, GianVincenzo Zuccotti.
Nutrients, 2019 Jun 27; 11(6). PMID: 31234330    Free PMC article.
The Habitual Diet of Dutch Adult Patients with Eosinophilic Esophagitis Has Pro-Inflammatory Properties and Low Diet Quality Scores.
Marlou L A de Kroon, Simone R B M Eussen, +6 authors, Berber J Vlieg-Boerstra.
Nutrients, 2021 Jan 17; 13(1). PMID: 33451130    Free PMC article.
Non-IgE- or Mixed IgE/Non-IgE-Mediated Gastrointestinal Food Allergies in the First Years of Life: Old and New Tools for Diagnosis.
Mauro Calvani, Caterina Anania, +8 authors, Elisabetta Veronelli.
Nutrients, 2021 Jan 21; 13(1). PMID: 33466746    Free PMC article.
Eosinophilic esophagitis: clinical, endoscopic, histologic and therapeutic differences and similarities between children and adults.
Pierfrancesco Visaggi, Edoardo Savarino, +12 authors, Nicola de Bortoli.
Therap Adv Gastroenterol, 2021 Feb 23; 14. PMID: 33613690    Free PMC article.
Dietary Management of Eosinophilic Esophagitis: Tailoring the Approach.
Pierfrancesco Visaggi, Lucia Mariani, +11 authors, Nicola de Bortoli.
Nutrients, 2021 Jun 03; 13(5). PMID: 34066243    Free PMC article.
Nutritional Aspects of Pediatric Gastrointestinal Diseases.
Teresa Di Chio, Christiane Sokollik, +4 authors, Osvaldo Borrelli.
Nutrients, 2021 Jul 03; 13(6). PMID: 34205445    Free PMC article.