The top food allergens targeted in the six-food elimination diet used in Eosinophilic Esophagitis are milk, soy, eggs, wheat, peanuts/tree nuts, and shellfish/fish.
, with multiple reasons accounting for this. In addition, sequential reintroduction with repeat endoscopy and biopsy to assess response is inconvenient and time-consuming and can incur significant direct and indirect costs.
However, of note, studies have demonstrated that children with IgE-mediated hypersensitivity to milk products are able to tolerate baked milk products., which included 18 patients for whom cow's milk was a demonstrated EoE trigger. For 10 of these patients, milk was the only food trigger, whereas the other eight patients had an additional identified food trigger .
Although this is a small single-center study, it was remarkably well done and used clearly characterized patients with milk sensitivity and EoE.Despite the finding that clinicians view dietary therapy as the least-effective treatment for EoE, such approaches nonetheless have efficacy and are likely a much better option in terms of cost-effectiveness and safety profile.
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