title: Identification of specific foods responsible for inflammation in children with eosinophilic esophagitis successfully treated with empiric elimination diet.
abstract: OBJECTIVE
  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.
  
  
  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  (25 M/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.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. akagalwa@childrensmemorial.org
authors.forename: Amir F
authors.initials: AF
authors.lastname: Kagalwalla
authors.forename: Ameesh
authors.initials: A
authors.lastname: Shah
authors.forename: B U K
authors.initials: BU
authors.lastname: Li
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Sentongo
authors.forename: Sally
authors.initials: S
authors.lastname: Ritz
authors.forename: Maria
authors.initials: M
authors.lastname: Manuel-Rubio
authors.forename: Katie
authors.initials: K
authors.lastname: Jacques
authors.forename: Deli
authors.initials: D
authors.lastname: Wang
authors.forename: Hector
authors.initials: H
authors.lastname: Melin-Aldana
authors.forename: Suzanne P
authors.initials: SP
authors.lastname: Nelson
mesh_terms: D000818:Animals; D000941:Antigens / Q000032:analysis*; D052179:Antigens, Plant / Q000009:adverse effects; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004032:Diet; D004531:Eggs / Q000009:adverse effects; D057765:Eosinophilic Esophagitis / Q000178:diet therapy* / Q000276:immunology* / Q000473:pathology; D004947:Esophagus / Q000276:immunology / Q000473:pathology; D005260:Female; D005502:Food / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008892:Milk / Q000009:adverse effects; D009092:Mucous Membrane / Q000276:immunology / Q000473:pathology; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D017747:Seafood / Q000009:adverse effects
chemical_list: D000941:Antigens; D052179:Antigens, Plant