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Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests.
Ann Allergy Asthma Immunol 2005; 95(4):336-43AA

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.

Authors+Show Affiliations

Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Pennsylvania 19104-4399, USA. spergel@email.chop.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

16279563

Citation

Spergel, Jonathan M., et al. "Treatment of Eosinophilic Esophagitis With Specific Food Elimination Diet Directed By a Combination of Skin Prick and Patch Tests." Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology, vol. 95, no. 4, 2005, pp. 336-43.
Spergel JM, Andrews T, Brown-Whitehorn TF, et al. Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests. Ann Allergy Asthma Immunol. 2005;95(4):336-43.
Spergel, J. M., Andrews, T., Brown-Whitehorn, T. F., Beausoleil, J. L., & Liacouras, C. A. (2005). Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests. Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology, 95(4), pp. 336-43.
Spergel JM, et al. Treatment of Eosinophilic Esophagitis With Specific Food Elimination Diet Directed By a Combination of Skin Prick and Patch Tests. Ann Allergy Asthma Immunol. 2005;95(4):336-43. PubMed PMID: 16279563.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests. AU - Spergel,Jonathan M, AU - Andrews,Timothy, AU - Brown-Whitehorn,Terri F, AU - Beausoleil,Janet L, AU - Liacouras,Chris A, PY - 2005/11/11/pubmed PY - 2005/12/13/medline PY - 2005/11/11/entrez SP - 336 EP - 43 JF - Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology JO - Ann. Allergy Asthma Immunol. VL - 95 IS - 4 N2 - 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. SN - 1081-1206 UR - https://www.unboundmedicine.com/medline/citation/16279563/Treatment_of_eosinophilic_esophagitis_with_specific_food_elimination_diet_directed_by_a_combination_of_skin_prick_and_patch_tests_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1081-1206(10)61151-9 DB - PRIME DP - Unbound Medicine ER -