Currently there is no consensus on the optimal treatment of eosinophilic esophagitis (EoE). One of the options, an elimination diet guided by allergy test results, has been shown to be effective to varying degrees with greater efficacy in pediatric cohorts . However, results in adults have been less promising as higher rates of negative allergy tests hinder efforts to guide the diet . This study explores the results of allergy-test directed elimination diets in a group of patients (n = 16) treated at the Allergy & Immunology Clinic in London, Ontario.
A retrospective chart review was performed using a database of patients diagnosed with EoE (histology >=15 eo/hpf in esophageal biopsy) and treated at the Allergy & Immunology Clinic at St. Joseph’s Hospital, London, ON. Patients were included in the review if they had been prescribed an elimination diet guided by allergy testing (skin-prick test (SPT) and/or atopy patch test (APT)), and had esophageal biopsies taken >=8 weeks after initiation of the diet.
Pre-treatment eosinophil counts were recorded from peak eosinophil counts of the most recent biopsy prior to initiation of the elimination diet.
The average age of subjects at diet initiation was 43.75 years. On average, each subject eliminated 1.7 foods from their diet. Post-diet biopsies displayed a significantly lower level of peak eosinophils/hpf compared to pre-diet biopsies on average (37.9 vs. 89.8, p = 0.043). Three patients had post-diet biopsies below the histological threshold of diagnosis for EoE (<15 eo/hpf).
This chart review shows that patients undergoing elimination diets directed by allergy tests have significant histological improvement after their diets. It must be noted that this review did not control for the effects of confounding treatments such as PPIs and corticosteroids, with the latter being of greater concern to histological results. Half of the subjects examined (8 out of 16) had been, at some time before the post-diet biopsy, prescribed swallowed corticosteroids for EoE. However, only 1/4 of steroid-prescribed subjects reported using the steroids during the 30-day period immediately prior to their post-diet biopsy.
1. Spergel JM, Brown-Whitehorn TF, Cianferoni A, Shuker M, Wang ML, Verma R, Liacouras CA: Identification of causative foods in children with eosinophilic esophagitis treated with an elimination diet. The Journal of allergy and clinical immunology 2012, 130:461-467 e465.
2. Vernon N, Shah S, Lehman E, Ghaffari G: Comparison of atopic features between children and adults with eosinophilic esophagitis. Allergy and asthma proceedings : the official journal of regional and state allergy societies 2014, 35:409-414.