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The Role of Allergy Testing in Eosinophilic Esophagitis: an Update of the Evidence

  • Esophagus (E Dellon, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Opinion statement

Allergy testing has been advocated for patients with eosinophilic esophagitis (EoE) as a means of defining food triggers and directing dietary therapy. Several recent and comprehensive studies have demonstrated the futility of skin prick (SPT), skin patch (APT) and serum food antigen specific IgE (SIgE) estimates in this context. Furthermore, if identification of food triggers is the endpoint (as opposed to the ability of an allergy test-directed diet merely to induce remission), previous positive studies have limitations. Evolving evidence that EoE may be a non-IgE-mediated disease has led to trials of new assays including serum IgG to food allergens, the cytokine thymic stromal lymphopoietin (TSLP) and basophil activation, all without success. Rather than using allergy test-directed diets, the clinician should use empirical elimination diets which are practical, and consider minimally invasive sampling of the oesophagus to facilitate dietary reintroduction. Research should be redoubled to consider not only assays to predict food triggers but also those that monitor disease activity. The anti-inflammatory effect of proton pump inhibitors and deficits in barrier integrity may influence the success of dietary therapy and the results of allergy tests and should be considered in future research design.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •Of importance ••Of major importance

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Authors and Affiliations

  1. Department of Respiratory and Sleep Medicine Eastern Health, Monash University, 3 Arnold St Box Hill, Melbourne, 3128, Australia

    Hamish Philpott FRACP & Francis Thien MD, FRACP

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  1. Hamish Philpott FRACP
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  2. Francis Thien MD, FRACP
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Correspondence to Hamish Philpott FRACP.

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Hamish Philpott declares that he has no conflict of interest.

Francis Thien declares that he has no conflict of interest.

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This article is part of the Topical Collection on Esophagus

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Philpott, H., Thien, F. The Role of Allergy Testing in Eosinophilic Esophagitis: an Update of the Evidence. Curr Treat Options Gastro 15, 26–34 (2017). https://doi.org/10.1007/s11938-017-0125-3

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