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Dietary Therapy for Eosinophilic Esophagitis: Elimination and Reintroduction

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Abstract

Eosinophilic esophagitis (EoE) is a food antigen-mediated disorder of the esophagus characterized by eosinophil predominant inflammation and symptoms of esophageal dysfunction. Dietary antigen elimination induces clinical and histological remission in patients with EoE. The most restrictive of elimination diets (the elemental diet) removes all possible food antigens while empiric elimination diets remove all (or a subset) of food antigens most commonly reported to cause esophageal eosinophilia and food allergies (milk, egg, wheat, soy, peanuts, tree nuts, fish, or legumes). Elimination diets are effective treatments for EoE but pose psychosocial and financial challenges to patients and consequently may impair quality of life. Foods that are commonly eliminated, especially milk, are also nutrient-dense and therefore their elimination may result in inadequate nutrient intake or deficiencies without careful diet planning to include nutritionally comparable and safe food substitutes. After remission is achieved with elimination diets, foods can be reintroduced sequentially to identify specific food triggers, but this reintroduction is not standardized. Food elimination and food reintroductions should consider the patient’s lifestyle, nutrition needs, and skills and ideally be managed by a team with knowledge of eosinophilic gastrointestinal disorders and nutrition.

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Authors and Affiliations

  1. Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, MLC 2010, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA

    Kara L. Kliewer

  2. Division of Nutrition Therapy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Alison M. Cassin

  3. Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Colorado Children’s Hospital, Aurora, CO, USA

    Carina Venter

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  1. Kara L. Kliewer
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  2. Alison M. Cassin
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  3. Carina Venter
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Correspondence to Kara L. Kliewer.

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KK declares no conflicts of interest. AC has received honoraria from Nutricia and Abbott Nutrition. CV has received honoraria from Danone, Nestle, Mead Johnson, and DBV Technologies.

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This article does not contain any studies with human participants or animals performed by any of the authors. The present article is a review; therefore, no informed consent was required.

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Kliewer, K.L., Cassin, A.M. & Venter, C. Dietary Therapy for Eosinophilic Esophagitis: Elimination and Reintroduction. Clinic Rev Allerg Immunol 55, 70–87 (2018). https://doi.org/10.1007/s12016-017-8660-1

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