Allergy‐test‐driven elimination diet is useful in children with eosinophilic esophagitis, regardless of the severity of symptoms

Abstract

All children with EoE and mild symptoms had resolution of symptoms and normal eosinophils in the esophageal mucosa a year after an allergy-driven elimination diet. Patients with moderate/severe EoE symptoms had the same improvement, indicating that an elimination diet is an efficient complementary treatment to corticosteroids.

Skin testing‐directed elimination diet – is 100% efficacy conceivable in eosinophilic esophagitis?

“…As professionals largely involved in the management of patients with eosinophilic esophagitis (EoE), we have read with great interest the study by Syrigou et al. evaluating the efficacy of allergy testing‐directed elimination diet in pediatric EoE . At first, we were puzzled by the reported 100% clinical and histological remission rate with this dietary intervention, even higher than that shown for the most restrictive and effective elimination diets in EoE: elemental diet (90%) and empiric six‐food elimination diet (SFED) (72%), according to a recent meta‐analysis .…”

Illuminating Elimination Diets: Controversies Regarding Dietary Treatment of Eosinophilic Esophagitis

“…While the immediate effectiveness of elimination diets is well described, 27,28,30,33,[33][34][35][36]39,49,50,[63][64][65] relatively little is known about its long-term effectiveness.…”

“…Therefore, diets are constructed based on the allergy test results. While this approach makes intuitive sense, such diets are only modestly (35 -55%) effective for histologic remission, 33,39,49,50 since EoE is not an IgE-based disorder, which is what skin prick and serum-specific tests assess, and atopy patch testing has been reliable in only a few clinical settings. 31,51 As such, there is poor agreement (13% or less) between these test results and food triggers determined clinically by dietary elimination and reintroduction.…”

The Editor recommends this issue's articles to the reader

“…In this study, Syrigou et al. investigated the culprit allergens and the effect of tailor‐made allergy test‐driven dietary manipulations in two groups of pediatric patients with EoE of different severity (mild or severe symptomatology, respectively). According to their results, patients with mild symptoms responded – both clinically and histologically – to allergen‐driven elimination diets without the need of pharmaceutical treatment, while in more severe cases, the above dietary manipulations were shown to contribute to resolution of symptoms, histological improvement, or prevention of relapse after cessation of steroids.…”