title: Allergy-test-driven elimination diet is useful in children with eosinophilic esophagitis, regardless of the severity of symptoms.
abstract: BACKGROUND
  A combination of PPIs and corticosteroids is the pharmacotherapy mostly used to treat eosinophilic esophagitis (EoE), while dietetic manipulations consist also an efficient option. The aim of this study was to compare the efficacy of allergy-test-driven elimination diet in children with mild symptoms of EoE to a group of children with moderate/severe symptoms.
  
  
  METHODS
  Thirty-five children, aged 7 months to 12 yr, with EoE were enrolled in the study. They had a clinical history of GERD-like (21 children, Group A) or more severe symptoms (14 children, Group B). The diagnosis had been confirmed after two preliminary months of therapy with PPIs and an esophagogastroduodenoscopy. Soon after diagnosis, they were allergy-tested, using IgE detection (SPT and serum-specific IgE) and atopy patch tests (APTs). A 12-month tailor-made diet was prescribed according to the tests. Patients of Group B continued PPIs for two more months, while swallowed topical steroids were also prescribed to them for the first 5 months after diagnosis, followed by an 'as-needed' use of them for the rest of the study. Endoscopy was repeated at the end of the study.
  
  
  RESULTS
  Milk and egg were the most common APT-positive allergens. Thirty-two patients were instructed to follow an elimination diet, which was completed by 15/18 of Group A and 12/14 of Group B. An improvement of symptoms was reported by 26/27 patients that completed the study. The use of swallowed corticosteroids was noticeably decreased during the as-needed period, in Group B. A remarkable reduce of eosinophils was noticed in biopsies; from 42.84 ± 18.08, they decreased to 6.41 ± 3.20, a year after.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Allergy Department, 'Sotiria' General Hospital, Athens, Greece.
authors.forename: Ekaterini
authors.initials: E
authors.lastname: Syrigou
authors.affiliation: First Department of Paediatrics, University of Athens, Athens, Greece.
authors.forename: Aspasia
authors.initials: A
authors.lastname: Angelakopoulou
authors.affiliation: Allergy Department, 'Sotiria' General Hospital, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Zande
authors.affiliation: First Department of Paediatrics, University of Athens, Athens, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Panagiotou
authors.affiliation: First Department of Paediatrics, University of Athens, Athens, Greece.
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Roma
authors.affiliation: Dept of Nutrition and Dietetics, Harokopio University, Athens, Greece.
authors.forename: Constantinos
authors.initials: C
authors.lastname: Pitsios
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004032:Diet / Q000379:methods*; D057765:Eosinophilic Esophagitis / Q000150:complications* / Q000178:diet therapy* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D005512:Food Hypersensitivity / Q000145:classification* / Q000150:complications* / Q000175:diagnosis / Q000178:diet therapy; D006801:Humans; D007223:Infant; D008297:Male; D010328:Patch Tests; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index
chemical_list: D000305:Adrenal Cortex Hormones; D054328:Proton Pump Inhibitors
keywords: elimination diet; eosinophilic esophagitis; gastroesophageal reflux disease; skin testing