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Pediatric allergy testing identified foods causing eosinophilic esophagitis
Children with eosinophilic esophagitis who followed allergy testing-directed diets experienced similar success rates to those achieved with empiric food removal in a recent study.
In a retrospective analysis, researchers evaluated 793 children with eosinophilic esophagitis (EoE) treated at The Children’s Hospital of Philadelphia between 2000 and 2011. Participants received skin prick (SPT) and atopy patch tests (APT) and were assigned elimination diets based on the results, with esophageal biopsies performed to determine the impact of food reintroduction.
“We have found that food allergies cause [EOE] in previous studies,” Jonathan M. Spergel, MD, PhD, director of the Center for Pediatric Eosinophilic Disorders at The Children’s Hospital of Philadelphia, told Healio.com. “However, it was unclear what was the best method for identifying foods. In this study, we explored different methods.”
Causative foods were identified among 319 participants. Milk, eggs, wheat and soy were the most common foods linked to EoE symptoms that included vomiting and abdominal pain. Food combinations most frequently causative of EoE included milk with one or more meats and milk, eggs, wheat and soy. Milk in combination with another food was considered causative in more than 66% of participants.
Responses to elimination diets were similar to those reported elsewhere after empiric removal of the eight most commonly causative foods: milk, egg, wheat, soy, peanuts, tree nuts, fish and shellfish (53% for both methods). However, diets based on SPT/APT results led to the removal of fewer foods, with an average of 3.2 ± 0.13 foods from SPT results and 2.7 ± 0.10 from APT. Removal of milk in addition to foods indicated through test results led to a 77% response rate, as did elimination from the most common food groups (milk, egg, soy, wheat, chicken, turkey, beef and pork).
“For the identification of food, an empiric diet or allergy testing-based methods have had equal success in pediatric patients with EoE,” the researchers wrote. “The one potential advantage for allergy testing was that fewer foods were removed. This must be weighed against the time and effort for testing and preparation.”
Disclosure: See the study for a full list of relevant disclosures.