Food Intolerances and Eosinophilic Esophagitis in Childhood


Food intolerance is an adverse reaction to a particular food or ingredient that may or may not be related to the immune system. A deficiency in digestive enzymes can also cause some types of food intolerances like lactose and gluten intolerance. Food intolerances may cause unpleasant symptoms, including nausea, bloating, abdominal pain, and diarrhea, which usually begin about half an hour after eating or drinking the food in question, but sometimes symptoms may delayed up to 48 h. There is also a strong genetic pattern to food intolerances. Intolerance reactions to food chemicals are mostly dose-related, but also some people are more sensitive than others. Diagnosis can include elimination and challenge testing. Food intolerance can be managed simply by avoiding the particular food from entering the diet. Babies or younger children with lactose intolerance can be given soy milk or hypoallergenic milk formula instead of cow’s milk. Adults may be able to tolerate small amounts of troublesome foods, so may need to experiment. Eosinophilic esophagitis (EE) is defined as isolated eosinophilic infiltration in patients with reflux-like symptoms and normal pH studies and whose symptoms are refractory to acid-inhibition therapy. Food allergy, abnormal immunologic response, and autoimmune mechanisms are suggested as possible etiological factors for EE. This article is intended to review the current literature and to present a practical approach for managing food intolerances and EE in childhood.

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  1. 1.

    Ozol D, Mete E (2008) Asthma and food allergy. Curr Opin Pulm Med 14:9–12. doi:10.1097/MCP.0b013e3282f1981c

    PubMed  Article  Google Scholar 

  2. 2.

    Olives JP, Breton A (1998) Food allergies and intolerances in children. Rev Prat 48(4):389–393

    PubMed  CAS  Google Scholar 

  3. 3.

    Ortolani C, Pastorello EA (2006) Food allergies and food intolerances. Best Pract Res Clin Gastroenterol 20(3):467–483. doi:10.1016/j.bpg.2005.11.010

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Kitts D, Yuan Y, Joneja J, Scott F, Szilagyi A, Amiot J, Zarkadas M (1997) Adverse reactions to food constituents: allergy, intolerance, and autoimmunity. Can J Physiol Pharmacol 75(4):241–254. doi:10.1139/cjpp-75-4-241

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Briet F, Pochart P, Marteau P, Flourie B, Arrigoni E, Rambaud JC (1997) Improved clinical tolerance to chronic lactose ingestion in subjects with lactose intolerance: a placebo effect? Gut 41(5):632–635

    PubMed  CAS  Article  Google Scholar 

  6. 6.

    Suarez FL, Savaiano DA, Levitt MD (1995) Review article: the treatment of lactose intolerance. Aliment Pharmacol Ther 9:589–597

    PubMed  CAS  Google Scholar 

  7. 7.

    Saavedra JM, Perman JA (1989) Current concepts in lactose malabsorption and intolerance. Annu Rev Nutr 9:475–502. doi:10.1146/

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Montgomery RK, Krasinski SD, Hirschhorn JN, Grand RJ (2007) Lactose and lactase – who is lactose intolerant and why? J Pediatr Gastroenterol Nutr 45:S131–137. doi:10.1097/MPG.0b013e318058ca95

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Karry A, Jackson BS, Dennis A (2001) Savaiano lactose maldigestion, calcium intake and osteoporosis in African-, Asian-, and Hispanic-Americans. J Am Coll Nutr 20:198S–207S

    Google Scholar 

  10. 10.

    Rasinpera H, Savilahti E, Enattah NS et al (2004) A genetic test which can be used to diagnose adult-type hypolactasia in children. Gut 53(11):1571–1576. doi:10.1136/gut.2004.040048

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Buning C, Genschel J, Jurga J et al (2005) Introducing genetic testing for adult-type hypolactasia. Digestion 71(4):245–250. doi:10.1159/000087050

    PubMed  Article  Google Scholar 

  12. 12.

    Ridefelt P, Hakansson LD (2005) Lactose intolerance: lactose tolerance test versus genotyping. Scand J Gastroenterol 40(7):822–826. doi:10.1080/00365520510015764

    PubMed  Article  Google Scholar 

  13. 13.

    Ojetti V, Nucera G, Migneco A et al (2005) High prevalence of celiac disease in patients with lactose intolerance. Digestion 71(2):106–110. doi:10.1159/000084526

    PubMed  Article  Google Scholar 

  14. 14.

    Capano G, Guandalini S, Guarino A et al (1984) Enteric infections, cow’s milk intolerance and parenteral infections in 118 consecutive cases of acute diarrhea in children. Eur J Pediatr 142(4):281–285. doi:10.1007/BF00540253

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Jarvela I, Enattah NS, Kokkonen J et al (1998) Assignment of the locus for congenital deficiency to 2q21, in the vicinity of but separate from the Lactase-Phlorizin Hydrolase Gene. Am J Hum Genet 63:1078–1085. doi:10.1086/302064

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Di Camillo M, Marinaro V, Argnani F et al (2006) Hydrogen breath test for diagnosis of lactose malabsorption: the importance of timing and the number of breath samples. Can J Gastroenterol 20(4):265–268

    PubMed  Google Scholar 

  17. 17.

    Montalto M, Curigliano V, Santoro L et al (2006) Management and treatment of lactose malabsorption. World J Gastroenterol 12(2):187–191

    PubMed  CAS  Google Scholar 

  18. 18.

    Cappello G, Marzio L (2005) Rifaximin in patients with lactose intolerance. Dig Liver Dis 37(5):316–319. doi:10.1016/j.dld.2004.12.007

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Genkinger JM, Hunter DJ, Spiegelman D et al (2006) Dairy products and ovarian cancer: a pooled analysis of 12 cohort studies. Cancer Epidemiol Biomarkers Prev 15(2):364–372. doi:10.1158/1055-9965.EPI-05-0484

    PubMed  Article  Google Scholar 

  20. 20.

    Roberts G, Lack G (2003) Food allergy and asthma – what is the link? Paediatr Respir Rev 4(3):205–212. doi:10.1016/S1526-0542(03)00058-7

    PubMed  Article  Google Scholar 

  21. 21.

    Gupta SK (2007) Update on infantile colic and management options. Curr Opin Investig Drugs 8:921–926

    PubMed  CAS  Google Scholar 

  22. 22.

    Savino F (2007) Focus on infantile colic. Acta Paediatr 96(9):1259–1264. doi:10.1111/j.1651-2227.2007.00428.x

    PubMed  Article  Google Scholar 

  23. 23.

    Hogan SP, Rothenberg ME (2006) Eosinophil function in eosinophil-associated gastrointestinal disorders. Curr Allergy Asthma Rep 6(1):65–71. doi:10.1007/s11882-006-0013-8

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Liacouras CA, Ruchelli E (2004) Eosinophilic esophagitis. Curr Opin Pediatr 16(5):560–566. doi:10.1097/01.mop.0000141071.47572.eb

    PubMed  Article  Google Scholar 

  25. 25.

    Fogg MI, Ruchelli E, Spergel JM (2003) Pollen and eosinophilic esophagitis. J Allergy Clin Immunol 112:796–797. doi:10.1016/S0091-6749(03)01715-9

    PubMed  Article  Google Scholar 

  26. 26.

    Hogan SP, Mishra A, Brandt EB et al (2001) A pathological function for eotaxin and eosinophils in eosinophilic gastrointestinal inflammation. Nat Immunol 2(4):353–360. doi:10.1038/86365

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Dauer EH, Freese DK, El-Youssef M et al (2005) Clinical characteristics of eosinophilic esophagitis in children. Ann Otol Rhinol Laryngol 114(11):827–833

    PubMed  Google Scholar 

  28. 28.

    Liacouras CA (2003) Eosinophilic esophagitis in children and adults. J Pediatr Gastroenterol Nutr 37(Suppl 1):S23–28. doi:10.1097/00005176-200311001-00006

    PubMed  Google Scholar 

  29. 29.

    Spergel JM et al (2002) The use of skin pricks tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol 109:363–368. doi:10.1067/mai.2002.121458

    PubMed  Article  Google Scholar 

  30. 30.

    Assa’ad A (2005) Detection of causative foods by skin prick and atopy patch tests in patients with eosinophilic esophagitis: things are not what they seem. Ann Allergy Asthma Immunol 95(4):309–311

    PubMed  Article  Google Scholar 

  31. 31.

    Furuta GT, Liacouras CA, Collins MH et al (2007) First International Gastrointestinal Eosinophil Research Symposium (FIGERS) Subcommittees. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 133:1342–1363. doi:10.1053/j.gastro.2007.08.017

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Orenstein SR, Shalaby TM, Di Lorenzo C et al (2000) The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children. Am J Gastroenterol 95:1422–1430. doi:10.1111/j.1572-0241.2000.02073.x

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Kaplan M et al (2003) Endoscopy in eosinophilic esophagitis: “feline” esophagus and perforation risk. Clin Gastroenterol Hepatol 1:433–443. doi:10.1016/S1542-3565(03)00222-2

    PubMed  Article  Google Scholar 

  34. 34.

    Straumann A, Spichtin HP, Grize L et al (2003) Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. Gastroenterology 125:1660–1669. doi:10.1053/j.gastro.2003.09.024

    PubMed  Article  Google Scholar 

  35. 35.

    Kaplan M, Mutlu EA, Jakate S et al (2003) Endoscopy in eosinophilic esophagitis: “feline” esophagus and perforation risk. Clin Gastroenterol Hepatol 1:433–437. doi:10.1016/S1542-3565(03)00222-2

    PubMed  Article  Google Scholar 

  36. 36.

    Markowitz JE et al (2003) Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents. Am J Gastroenterol 98:777–782. doi:10.1111/j.1572-0241.2003.07390.x

    PubMed  Article  CAS  Google Scholar 

  37. 37.

    Noel RJ, Putnam PE, Collins MH, Assa’ad AH et al (2004) Clinical and immunopathologic effects of swallowed fluticasone for eosinophilic esophagitis. Clin Gastroenterol Hepatol 2(7):568–575. doi:10.1016/S1542-3565(04)00240-X

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Attwood SE et al (2003) Eosinophilic oesophagitis: a novel treatment using Montelukast. Gut 52:181–185. doi:10.1136/gut.52.2.181

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Garrett JK, Jameson SC, Thomson B et al (2004) Anti-interleukin-5 (mepolizumab) therapy for hypereosinophilic syndromes. J Allergy Clin Immunol 113(1):115–119. doi:10.1016/j.jaci.2003.10.049

    PubMed  Article  CAS  Google Scholar 

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Correspondence to Duygu Ozol.

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Ozdemir, O., Mete, E., Catal, F. et al. Food Intolerances and Eosinophilic Esophagitis in Childhood. Dig Dis Sci 54, 8–14 (2009).

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  • Food intolerance
  • Lactose
  • Eosinophilic esophagitis