Document Detail

Identification of causative foods in children with eosinophilic esophagitis treated with an elimination diet.
MedLine Citation:
PMID:  22743304     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Eosinophilic esophagitis (EoE) is a chronic inflammatory disease with isolated eosinophils in the esophagus predominantly triggered by foods. The optimal testing to identify inciting foods remains unclear.
OBJECTIVES: We sought to determine the effectiveness of allergy testing-directed diets in patients with EoE.
METHODS: A retrospective analysis of all children with EoE seen at the Children's Hospital of Philadelphia between 2000 and 2011 identified 941 patients with EoE. Skin prick tests (SPTs) and atopy patch tests (APTs) were conducted, and predictive values were calculated. IgE-mediated food reactions were also identified. A food was considered to cause EoE if its elimination led to resolution of esophageal eosinophilia or reintroduction led to reoccurrence of EoE. The effectiveness of the various elimination diets was compared with targeted food antigen elimination.
RESULTS: Definitive foods causing EoE were identified, with milk, egg, wheat, and soy as the most common foods in 319 patients. IgE-mediated reactions (urticaria and anaphylaxis) were seen in 15%. The negative predictive value for the combination of SPTs and APTs averaged 92%, with the exception of milk at 44%, and the positive predictive value averaged 44%. An empiric 6-food elimination diet or removal of positive foods on allergy testing (SPTs/APTs) both had a histologic success rate of 53%. Removal of foods identified on SPTs/APTs plus empiric elimination of milk leads to resolution in 77% of patients.
CONCLUSION: An elimination diet based on SPT/APT results leads to resolution of esophageal eosinophilia in a similar proportion of patients as empiric removal of foods but required that fewer foods be removed. These observations suggest that both methods are acceptable options.
Jonathan M Spergel; Terri F Brown-Whitehorn; Antonella Cianferoni; Michele Shuker; Mei-Lun Wang; Ritu Verma; Chris A Liacouras
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-06-27
Journal Detail:
Title:  The Journal of allergy and clinical immunology     Volume:  130     ISSN:  1097-6825     ISO Abbreviation:  J. Allergy Clin. Immunol.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-31     Completed Date:  2012-10-17     Revised Date:  2014-04-08    
Medline Journal Info:
Nlm Unique ID:  1275002     Medline TA:  J Allergy Clin Immunol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  461-7.e5     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Anaphylaxis / etiology,  immunology*,  pathology
Antigens / blood,  immunology
Child, Preschool
Eosinophilic Esophagitis / etiology,  immunology*,  pathology
Eosinophils / immunology*,  pathology
Esophagus / immunology*,  pathology
Food / adverse effects*
Food Hypersensitivity / complications*
Food, Formulated
Immunoglobulin E / blood,  immunology
Patch Tests
Retrospective Studies
Urticaria / etiology,  immunology*,  pathology
Reg. No./Substance:
0/Antigens; 37341-29-0/Immunoglobulin E
Comment In:
Gastroenterology. 2013 Jun;144(7):1560-1   [PMID:  23623872 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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