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In a prospective study of children with EoE, 8 weeks of 4-food elimination diet induced clinical, endoscopic, and histologic remission in more than 60% of children with EoE. Although less restrictive than 6-food elimination diet, 4-food elimination diet was nearly as effective, and can be recommended as a treatment for children with EoE.

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RATIONALE: Empiric six-food elimination diet is standard of care therapy for eosinophilic esophagitis (EoE). The efficacy of allergy testing in predicting dietary triggers of eosinophilia remains unclear. METHODS: We assessed the diagnostic accuracy of food-specific IgE (sIgE) and skin prick testing (SPT) for identifying specific EoE triggers. A multi-center prospective study of four-food elimination diet (FFED) was performed in children with EoE. Serum IgE and SPT to milk, wheat, egg and soy were analyzed in 35/50 (70%) FFED responders who underwent food reintroduction. RESULTS: 78 children underwent FFED (68% male, median age 8.4 years, 84% white, 83% atopic). Histologic remission occurred in 50 patients (64%). Cow's milk was a food trigger in 85%, wheat in 31%, egg in 13% and soy in 8%. Of the responders 17% were SPT positive to milk, 20% to egg, 14.7% to wheat and 26.5% to soy. Specific IgE was >0.35 in 40% to milk (median sIgE 0.85kU/L), 22.9% to egg (median 1.45kU/L); 20% to wheat (median 0.88kU/L) and 23.5% to soy (median 0.72kU/L). The diagnostic odds ratios were poor for both SPT and sIgE for all foods (range 0-1.9 for SPT and 0-12.8 for sIgEs). The accuracy of testing (both SPTand sIgE) was highest for egg (62.1% SPT, 80% sIgE), followed by soy (64.5% SPT, 75.9% sIgE) and wheat (57.8% SPT, 57.1% sIgE) and lowest to milk (15.8% SPT, 27.8% sIgE). CONCLUSIONS: Skin prick and sIgE testing were not accurate diagnostic predictors of food triggers in EoE patients on FFED based on assessment of esophageal histology.