EoE Module 8 References-Molina-Infante et al J Allergy Clin Immunol 2018 Dietary therapies for EoE

Molina-Infante et al J Allergy Clin Immunol 2018 Dietary therapies for EoE

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Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease of the esophagus, often triggered by food antigens. Key dietary interventions include elemental diets and empiric food elimination diets, but available food allergy tests are inadequate in precisely identifying triggers, especially for adults. The elemental diet, which uses amino acid-based formulas exclusively, is highly effective but challenging to implement due to taste and social factors. <br /><br />Empiric elimination diets, such as the 6-food elimination diet (6-FED), avoid common allergens like milk, wheat, eggs, soy, nuts, and seafood, showing a 72% effectiveness rate. However, this diet's social difficulty and need for multiple endoscopies are notable deterrents. Less restrictive approaches, like the 4-food elimination diet (4-FED) and the 2-food elimination diet (2-FED), have emerged, targeting the more prevalent triggers—milk, wheat/gluten, and egg—with reasonable success rates (43% for 2-FED, 54% in adults, and 64% in children for 4-FED).<br /><br />A step-up approach—beginning with less restriction and adding more foods if necessary (2-4-6)—can identify food triggers with fewer endoscopies, thus optimizing the process. Early promising evidence supports long-term efficacy with continued avoidance of identified triggers leading to drug-free remission. However, unresolved issues include potential nutritional deficits, the need for frequent endoscopies, and understanding food tolerance and allergy mechanisms more fully. Future research is crucial to refine dietary protocols and extend their applicability and effectiveness across different populations and environmental conditions.

Keywords

Eosinophilic esophagitis

immune-mediated disease

food antigens

elemental diet

food elimination diet

allergy tests

6-food elimination diet

4-food elimination diet

2-food elimination diet

food triggers