Eosinophilic esophagitis https://greenmedinfo.com/taxonomy/term/19104/all en "A 6-food elimination diet (SFED) excluding cow's milk, soy, wheat, egg, peanuts/tree nuts, and seafood has been shown to induce remission in a majority of children with EoE." https://greenmedinfo.com/article/6-food-elimination-diet-sfed-excluding-cows-milk-soy-wheat-egg-peanutstree-nut PMID:  J Pediatr Gastroenterol Nutr. 2011 Aug ;53(2):145-9. PMID: 21788754 Abstract Title:  Identification of specific foods responsible for inflammation in children with eosinophilic esophagitis successfully treated with empiric elimination diet. Abstract:  OBJECTIVES: Eosinophilic esophagitis (EoE) is an immune-mediated chronic inflammatory disorder triggered by food antigen(s). A 6-food elimination diet (SFED) excluding cow's milk, soy, wheat, egg, peanuts/tree nuts, and seafood has been shown to induce remission in a majority of children with EoE. The goal of the present study was to identify specific food antigens responsible for eosinophilic esophageal inflammation in children with EoE who had achieved histological remission with the SFED.PATIENTS AND METHODS: In this analysis, we retrospectively analyzed children with EoE who completed subsequent single-food reintroductions that led to identification of foods causing disease recurrence. Repeat upper endoscopy with biopsies was performed after single-food introductions. Recurrence of esophageal eosinophilia following a food reintroduction identified that food antigen as a cause of EoE.RESULTS: A total of 36/46 (25 M/11F) children who were initially successfully treated with SFED completed this trial; the mean age was 7.6  ±  4.3 years. The most common foods identified were 25 to cow's milk (74%), 8 to wheat (26%), 4 to eggs (17%), 3 to soy (10%), and 1 to peanut (6%). Milk was 8 times more likely to cause EoE compared with wheat, the next most common food (95% confidence interval 2.41-26.62, P = 0.0007).CONCLUSIONS: Serial single-food reintroductions following induction of histological remission with the SFED can lead to the identification of specific causal food antigen(s) in EoE. Cow's milk was the most common food identified in subjects with EoE treated with SFED. A subset of children with EoE may develop tolerance to their food sensitivities while on the SFED. https://greenmedinfo.com/article/6-food-elimination-diet-sfed-excluding-cows-milk-soy-wheat-egg-peanutstree-nut#comments Eosinophilic esophagitis Cow Milk Egg Peanut Soy Wheat Human Study Sat, 18 Feb 2012 18:11:17 +0000 greenmedinfo 72880 at https://greenmedinfo.com 50 adults with Eosinophilic esophagitis (EoE) were put on a 6-food elimination diet. Food reintroduction (esp. wheat & milk) re-initiated features of EoE, indicating a role for food allergens in its pathogenesis; skin-prick predicted only 13% of foods. https://greenmedinfo.com/article/50-adults-eosinophilic-esophagitis-eoe-were-put-6-food-elimination-diet-food-r PMID:  Gastroenterology. 2012 Mar 3. Epub 2012 Mar 3. PMID: 22391333 Abstract Title:  Elimination Diet Effectively Treats Eosinophilic Esophagitis in Adults; Food Reintroduction Identifies Causative Factors. Abstract:  BACKGROUND & AIMS: Adults with eosinophilic esophagitis (EoE) typically present with dysphagia and food impaction. A 6-food elimination diet (SFED) is effective in children with EoE. We assessed the effects of the SFED followed by food reintroduction on the histologic response, symptoms, and quality of life in adults with EoE. METHODS: At the start of the study, 50 adults with EoE underwent esophagogastroduodenoscopies (EGDs), biopsies, and skin-prick tests for food and aeroallergens. After 6 weeks of SFED, patients underwent repeat EGD and biopsies. Histologic responders, defined by≤5 eosinophils/high-power field (eos/hpf) (n = 32), underwent systematic reintroduction of foods followed by EGD and biopsies (n = 20). Symptom and quality of life scores were determined before and after SFED. RESULTS: Common symptoms of EoE included dysphagia (96%), food impaction (74%), and heartburn (94%). The mean peak eosinophil counts in the proximal esophagus were 34 eos/hpf and 8 eos/hpf, before and after the SFED, and 44 eos/hpf and 13 eos/hpf in the distal esophagus, respectively (P<.0001). After the SFED, 64% of patients had peak counts≤5 eos/hpf and 70% had peak counts of ≤10 eos/hpf. Symptom scores decreased in 94% (P<.0001). After food reintroduction, esophageal eosinophil counts returned to pretreatment values (P<.0001). Based on reintroduction, the foods most frequently associated with EoE were wheat (60% of cases) and milk (50% of cases). Skin-prick testing predicted only 13% of foods associated with EoE. CONCLUSIONS: An elimination diet significantly improves symptoms and reduces endoscopic and histopathologic features of EoE in adults. Food reintroduction re-initiated features of EoE in patients, indicating a role for food allergens in its pathogenesis. Foods that activated EoE were identified by systematic reintroduction analysis but not by skin-prick tests. https://greenmedinfo.com/article/50-adults-eosinophilic-esophagitis-eoe-were-put-6-food-elimination-diet-food-r#comments Eosinophilic esophagitis Food Allergies Dietary Modification: Cow's Milk/Casein Free Dietary Modification: Elimination Diet Dietary Modification: Wheat/Gluten Free Human Study Sat, 02 Jun 2012 01:11:24 +0000 greenmedinfo 76607 at https://greenmedinfo.com A study of 53 pediatric patients with eosinophilic esophagitis found most were highly atopic with frequent allergic sensitivities; the overall prevalence of food & inhalant sensitization was 80%, with higher total IgE levels in sensitized vs nonsensitized https://greenmedinfo.com/article/study-53-pediatric-patients-eosinophilic-esophagitis-found-most-were-highly-at PMID:  Ann Allergy Asthma Immunol. 2010 Jun ;104(6):496-502. PMID: 20568382 Abstract Title:  Serum IgE measurement and detection of food allergy in pediatric patients with eosinophilic esophagitis. Abstract:  BACKGROUND: Although associated allergies are common and the mechanism may include long-term exposure to allergens, measurement of serum specific IgE levels has not been studied in pediatric eosinophilic esophagitis (EE). OBJECTIVE: To compare the results of serum IgE testing, patch testing, and epicutaneous skin testing to measure allergic sensitization in pediatric patients with EE. METHODS: In a cross-sectional study of 53 pediatric patients with EE, relevant history was obtained by questionnaire, and patch testing to foods was performed. Food and inhalant sensitivities were also assessed using skin prick testing and serum specific IgE measurement. Streptavidin CAP was used to measure specific IgE to cross-reactive carbohydrate determinants and Helicobacter pylori. RESULTS: The overall prevalence of food and inhalant sensitization was 80%, with higher total IgE levels in sensitized vs nonsensitized patients (median, 150 vs 13 IU/mL; P<.001). For foods, serum IgE measurement detected more positive results than did skin prick testing. Specific IgE to milk was most common (43%). Inhalants were implicated as frequently as were foods. In keeping with this, 32% of patients had a cluster of multiple sensitivities that included pollens, soy, grains, peanut, and tree nuts and had higher total IgE levels (P = .001). Patch test results were interpreted as positive in 39% of patients (rye, wheat, and soy were the most common). CONCLUSIONS: Most, but not all, patients with EE are highly atopic individuals with frequent allergic sensitivities. Thus, serum IgE measurement of low-titer IgE antibody may be useful in identifying relevant food sensitivities and in distinguishing subgroups of patients with EE, making a more directed approach to food avoidance possible. https://greenmedinfo.com/article/study-53-pediatric-patients-eosinophilic-esophagitis-found-most-were-highly-at#comments Eosinophilic esophagitis Food Allergies IgE-Mediated Hypersensitivity Cow Milk Rye Soy Wheat Diseases that are Linked Human Study Sat, 02 Jun 2012 12:50:55 +0000 greenmedinfo 76635 at https://greenmedinfo.com Celiac disease, eosinophilic esophagitis, and immediate-type immunoglobulin E-mediated food allergy. https://greenmedinfo.com/article/celiac-disease-eosinophilic-esophagitis-and-immediate-type-immunoglobulin-e-me PMID:  J Investig Allergol Clin Immunol. 2011 ;21(1):73-5. PMID: 21370728 Abstract Title:  Eosinophilic esophagitis, celiac disease, and immunoglobulin E-mediated allergy in a 2-year-old child. Abstract:  Celiac disease, eosinophilic esophagitis, and urticaria are 3 manifestations of food allergy with different pathogenic mechanisms. We report the case of a 2-year-old child with digestive symptoms, slow growth, and severe asthma. The results of skin prick tests were positive to several foods. Endoscopy revealed eosinophilic esophagitis and celiac disease. Treatment consisted of a gluten-free diet and a 1-month course of oral corticosteroids. Endoscopy and biopsy findings were normal at 5 years of age. A gluten-free diet is the basis of treatment of celiac disease, but the role of an elimination diet in eosinophilic esophagitis is not well established. Our patient also developed urticaria when exposed to milk and egg.We present, to our knowledge, the first report of a patient with celiac disease, eosinophilic esophagitis, and immediate-type immunoglobulin E-mediated food allergy. https://greenmedinfo.com/article/celiac-disease-eosinophilic-esophagitis-and-immediate-type-immunoglobulin-e-me#comments Celiac Disease Eosinophilic esophagitis Food Allergies Food Allergy: Immunoglobulin E-mediated Urticaria Dietary Modification: Wheat/Gluten Free Gluten Human: Case Report Tue, 24 Apr 2012 00:48:39 +0000 greenmedinfo 74807 at https://greenmedinfo.com Food elimination may have value in treating adult eosinophilic esophagitis. https://greenmedinfo.com/article/food-elimination-may-have-value-treating-adult-eosinophilic-esophagitis PMID:  J Clin Gastroenterol. 2012 Feb 13. Epub 2012 Feb 13. PMID: 22334220 Abstract Title:  Successful Food Elimination Therapy in Adult Eosinophilic Esophagitis: Not All Patients are the Same. Abstract:  Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated, esophageal disease characterized by esophageal dysfunction and eosinophilic inflammation, manifested mainly as dysphagia and frequent food impaction. EoE is recognized into the spectrum of food allergy, but food sensitization studies used not to be efficient to identify the triggering food, because of what patients are frequently treated with topic steroids or even endoscopic esophageal dilation. Herein, we describe 3 adult patients-all suffering from EoE, but with different sensitization patterns-who were treated successfully with elimination diets. Allergy tests indicated no food sensitization for patient 1, but challenge with milk and wheat were positive. Food IgE-mediated allergies were found in patients 2 and 3; inflammation was resolved with food elimination. Lack of food allergy sensitization does not exclude the possibility of food allergies as a cause of EoE; elimination diets must therefore be considered as an effective diagnostic and treatment tool. https://greenmedinfo.com/article/food-elimination-may-have-value-treating-adult-eosinophilic-esophagitis#comments Eosinophilic esophagitis Cow Milk Wheat Human: Case Report Sat, 18 Feb 2012 18:06:09 +0000 greenmedinfo 72878 at https://greenmedinfo.com The elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents. https://greenmedinfo.com/article/elemental-diet-effective-treatment-eosinophilic-esophagitis-children-and-adole PMID:  Neurosci Lett. 2006 Sep 25;405(3):172-4. Epub 2006 Jul 26. PMID: 12738455 Abstract Title:  Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents. Abstract:  OBJECTIVE: Eosinophilic esophagitis (EoE), a disorder characterized by eosinophilic infiltration of the esophageal mucosa, has been defined in large part through published case reports and series leading to ambiguity in both diagnostic and treatment options. Corticosteroids, cromolyn, and elemental diet have all been reported as successful treatments for EoE. In this study, we sought to accurately define a population of patients with EoE and then assess their response to elemental diet. METHODS: A series of patients with chronic symptoms of gastroesophageal reflux disease and an isolated esophageal eosinophilia on esophagogastroduodenoscopy (EGD) were identified. Therapy with a proton pump inhibitor was instituted for 3 months, followed by repeat EGD when symptoms persisted. A 24-h pH probe study was performed, and those with significantly abnormal studies were excluded. The remaining patients were diagnosed with EoE and placed on an elemental diet for 1 month, followed by a repeat EGD. RESULTS: Of 346 patients with chronic gastroesophageal reflux disease symptoms and eosinophils on esophageal biopsy, 51 (14.7%) were ultimately diagnosed with EoE. There was significant improvement in vomiting, abdominal pain, and dysphagia after the elemental diet. The median number of esophageal eosinophils per high-powered field (HPF) decreased from 33.7 before the diet to 1.0 after the diet (p https://greenmedinfo.com/article/elemental-diet-effective-treatment-eosinophilic-esophagitis-children-and-adole#comments Eosinophilic esophagitis Dietary Modification: Elemental Diet Human Study Mon, 01 Feb 2010 03:15:28 +0000 greenmedinfo 50675 at https://greenmedinfo.com The six-food elimination diet and elemental diet have therapeutic value in treating eosinophilic esophagitis. https://greenmedinfo.com/article/six-food-elimination-diet-and-elemental-diet-have-therapeutic-value-treating-e PMID:  Clin Gastroenterol Hepatol. 2006 Sep;4(9):1097-102. Epub 2006 Jul 21. PMID: 16860614 Abstract Title:  Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Abstract:  BACKGROUND & AIMS: In children, eosinophilic esophagitis (EE) is predominantly, but not exclusively, a food-hypersensitivity disorder. A crystalline amino acid-based elemental diet (ELED) formula currently remains the most effective nutritional treatment in inducing clinical and histologic remission. However, compliance with an exclusive, poor-tasting liquid formulation is difficult.METHODS: This retrospective observational study assessed the short-term clinical and histologic responses of 2 cohorts of children with EE evaluated during 2 different time periods: one was treated with the standard 6-food elimination diet (SFED) and the other was treated with ELED. Of the 60 children who met the inclusion criteria and were compliant with the dietary protocol, 35 were treated with a diet excluding cow-milk protein, soy, wheat, egg, peanut, and seafood while allowing all other table foods and 25 were treated exclusively with ELED. Repeat esophageal biopsy specimens were obtained at least 6 weeks later.RESULTS: Twenty-six of 35 (74%) in the SFED group and 22 of 25 (88%) in the ELED group achieved significant improvement of esophageal inflammation ( https://greenmedinfo.com/article/six-food-elimination-diet-and-elemental-diet-have-therapeutic-value-treating-e#comments Eosinophilic esophagitis Dietary Modification: Elemental Diet Human Study Fri, 22 Apr 2011 18:58:43 +0000 greenmedinfo 63319 at https://greenmedinfo.com Treatment of eosinophilic esophagitis with specific food elimination diet is effective in at least 75% of the children treated. https://greenmedinfo.com/article/treatment-eosinophilic-esophagitis-specific-food-elimination-diet-effective-le PMID:  Ann Allergy Asthma Immunol. 2005 Oct;95(4):336-43. PMID: 16279563 Abstract Title:  Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests. Abstract:  BACKGROUND: Eosinophilic esophagitis (EE) is a recently described disorder identified in patients with symptoms suggestive of gastroesophageal reflux disease (GERD) but unresponsive to conventional reflux therapies. Therapies have included corticosteroids, elemental diet, and diet restriction. We report our experience with skin prick and atopy patch testing and food elimination diets in patients diagnosed as having EE.OBJECTIVE: To identify food antigens that cause EE and the characteristics of patients who respond to food elimination vs those who are unresponsive.METHODS: Patients diagnosed as having EE had restricted diets based on skin prick and atopy patch testing results. Additional biopsies were performed after 4 to 8 weeks of restricted diet. Demographics, atopic tendencies, and food antigens were identified retrospectively in our food allergy database.RESULTS: A total of 146 patients diagnosed as having EE were evaluated with skin prick and atopy patch testing. Thirty-nine patients had unequivocal demonstration of food causing EE, with normalization of biopsy results on elimination and reoccurrence on reintroduction. An additional 73 patients, for a total 112 (77%) of 146 patients, had resolution of their EE as demonstrated by biopsy results. Fifteen (10%) of 146 patients were nonresponders manifested by no significant reduction in esophageal eosinophils despite restricted diet based on skin prick and atopy patch testing. Egg, milk, and soy were identified most frequently with skin prick testing, whereas corn, soy, and wheat were identified most frequently with atopy patch testing.CONCLUSION: In more than 75% of patients with EE, both symptoms and esophageal inflammation can be significantly improved with dietary elimination of foods. Skin prick and atopy patch testing can help identify foods in most patients. https://greenmedinfo.com/article/treatment-eosinophilic-esophagitis-specific-food-elimination-diet-effective-le#comments Eosinophilic esophagitis Food Allergies Dietary Modification: Allergen Free Diet Dietary Modification: Elemental Diet Human Study Fri, 22 Apr 2011 19:02:44 +0000 greenmedinfo 63320 at https://greenmedinfo.com