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

Amir F. Kagalwalla*, Ameesh Shah, B. U.K. Li, Timothy A. Sentongo, Sally Ritz, Maria Manuel-Rubio, Katie Jacques, Deli Wang, Hector Melin-Aldana, Suzanne P. Nelson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

173 Scopus citations

Abstract

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(25M/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.

Original languageEnglish (US)
Pages (from-to)145-149
Number of pages5
JournalJournal of pediatric gastroenterology and nutrition
Volume53
Issue number2
DOIs
StatePublished - Aug 2011

Keywords

  • eosinophilic esophagitis
  • food antigens
  • treatment

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

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