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


CONCLUSIONS
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.
Spergel
Jonathan M
JM
Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Pennsylvania 19104-4399, USA. spergel@email.chop.edu
Andrews
Timothy
T
Brown-Whitehorn
Terri F
TF
Beausoleil
Janet L
JL
Liacouras
Chris A
CA
D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000009:adverse effects / Q000032:analysis; D000818:Animals; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D004802:Eosinophilia / Q000175:diagnosis / Q000178:diet therapy*; D004941:Esophagitis / Q000175:diagnosis / Q000178:diet therapy* / Q000473:pathology; D004947:Esophagus / Q000473:pathology; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000178:diet therapy* / Q000209:etiology / Q000473:pathology; D006801:Humans; D007223:Infant; D008297:Male; D008892:Milk / Q000009:adverse effects; D010063:Ovum; D012882:Skin Tests / Q000379:methods; D045730:Soy Foods / Q000009:adverse effects; D016896:Treatment Outcome; D014908:Triticum / Q000009:adverse effects; D003313:Zea mays / Q000009:adverse effects
D000485:Allergens