title: Should wheat, barley, rye, and/or gluten be avoided in a 6-food elimination diet?
abstract: Eosinophilic esophagitis (EoE), a food antigen-mediated disease, is effectively treated with the dietary elimination of 6 foods commonly associated with food allergies (milk, wheat, egg, soy, tree nuts/peanuts, and fish/shellfish). Because wheat shares homologous proteins (including gluten) with barley and rye and can also be processed with these grains, some clinicians have suggested that barley and rye might also trigger EoE as a result of cross-reaction and/or cross-contamination with wheat. In this article, we discuss the theoretical risks of cross-reactivity and cross-contamination among wheat, barley, and rye proteins (including gluten); assess common practices at EoE treatment centers; and provide recommendations for dietary treatment and future studies of EoE.
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Kara L
authors.initials: KL
authors.lastname: Kliewer
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Carina
authors.initials: C
authors.lastname: Venter
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Cassin
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: J Pablo
authors.initials: JP
authors.lastname: Abonia
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics and Medicine, University of California, San Diego and Rady Children's Hospital, San Diego, Calif.
authors.forename: Seema S
authors.initials: SS
authors.lastname: Aceves
authors.affiliation: Division of Gastroenterology, Tufts Medical Center, Boston, Mass.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Bonis
authors.affiliation: Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Dellon
authors.affiliation: Division of Gastroenterology, Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa.
authors.forename: Gary W
authors.initials: GW
authors.lastname: Falk
authors.affiliation: Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
authors.forename: Glenn T
authors.initials: GT
authors.lastname: Furuta
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Gonsalves
authors.affiliation: Section of Pediatric Gastroenterology, Hepatology and Nutrition, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Ind.
authors.forename: Sandeep K
authors.initials: SK
authors.lastname: Gupta
authors.affiliation: Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Hirano
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
authors.forename: Amir
authors.initials: A
authors.lastname: Kagalwalla
authors.affiliation: Division of Gastroenterology, Tufts Medical Center, Boston, Mass.
authors.forename: John
authors.initials: J
authors.lastname: Leung
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Vincent A
authors.initials: VA
authors.lastname: Mukkada
authors.affiliation: Division of Allergy and Immunology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Spergel
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. Electronic address: rothenberg@cchmc.org.
authors.forename: Marc E
authors.initials: ME
authors.lastname: Rothenberg
mesh_terms: D000485:Allergens / Q000276:immunology; D003429:Cross Reactions; D057765:Eosinophilic Esophagitis / Q000178:diet therapy* / Q000209:etiology / Q000276:immunology; D005512:Food Hypersensitivity / Q000150:complications* / Q000178:diet therapy / Q000276:immunology; D005983:Glutens / Q000276:immunology*; D001467:Hordeum / Q000276:immunology*; D006801:Humans; D012434:Secale / Q000276:immunology*; D014908:Triticum / Q000276:immunology*
chemical_list: D000485:Allergens; D005983:Glutens
keywords: 6-food elimination diet; Eosinophilic esophagitis; cross-reactivity; gluten; wheat