Advanced Practice Provider EoE Program (Live/Virtual) | October 2025-Q and A

Video Transcription

Video Summary

In this discussion, experts address eosinophilic esophagitis (EOE) management focusing on dietary triggers and treatment strategies. Empiric elimination diets, primarily the six-food elimination, remain standard due to limited direct allergen testing sensitivity. Beyond common allergens, legumes, beef, corn, and various grains may also trigger reactions, informed by pediatric data and European studies. There's caution around the risk of developing immediate hypersensitivity, especially with milk elimination, necessitating allergy evaluations before food reintroduction. Reintroduction protocols emphasize consuming a meaningful, patient-specific dose daily for clearer assessment. Cross-reactivity among mammalian milks (cow, goat, sheep) is high, advising avoidance during elimination. For holidays, medical therapies like topical steroids can bridge dietary lapses to prevent inflammation. Symptoms often poorly correlate with disease severity; thus, therapies like PPIs are encouraged before dietary changes. Emerging biomarkers like IgG4 and mucosal allergy testing show promise but are not yet clinically validated. Finally, while food additives and preservatives may impact gut health and atopy, concrete evidence linking them to EOE is limited, though diet improvement by reducing processed foods is beneficial.

Keywords

eosinophilic esophagitis

six-food elimination diet

food triggers

allergy evaluation

topical steroids