Eosinophilic esophagitis (EoE) involves an inflammatory response in the esophagus that causes stiffening or swelling and leads to difficulty swallowing or food getting stuck. High amounts of white blood cells called eosinophils are found in the esophagus tissue in people with this condition. In most cases, people with EoE have other allergic conditions such as asthma, rhinitis, eczema, or food allergy, or they have a family history of allergy. In fact, environmental or food allergies are considered to be the main triggers of the condition, along with acid reflux.
EoE was once thought to be a rare disease, but has recently been recognized more frequently in children and young adults. It is thought that the disease is increasing at a similar rate as other allergic diseases—asthma and allergic rhinitis.1
There are currently no FDA-approved drugs to treat EoE, but it is commonly treated with proton pump inhibitors (PPIs) and/or topical or inhaled corticosteroids that are swallowed to help reduce inflammation in the esophagus. Studies in children have found success with elimination diets, but studies in adults have not been as plentiful. A recent study published in the journal Clinical Gastroenterology and Hepatology sought to determine the efficacy of such diets in adults.2
Of 31 adults enrolled in the study, 22 followed a targeted elimination diet, in which foods identified as allergens by the patient or by skin prick testing were eliminated, and nine followed a six-food elimination diet (SFED) that removed dairy, wheat, nuts, eggs, seafood, and soy. The majority of patients following either diet experienced relief of symptoms as well as substantial decreases in accumulation of immune cells in esophageal tissue. No significant difference between effects of the two diets was detected.
“These strong results support dietary elimination therapy as an effective treatment for adults suffering from eosinophilic esophagitis,” stated W. Asher Wold, MD, MPH, lead author.
The study included patients for whom steroid therapy had not been effective, and its success is promising given the lack of other treatment options for this condition. Long-term steroid and PPI use is associated with many side effects, so knowing that there is an easy treatment that might reap additional health benefits given the allergic status of most of these individuals, is reassuring.
When anyone is experiencing any type of allergy it may be wise to eliminate the six foods mentioned above: wheat, dairy, nuts, eggs, seafood, and soy. This could be done for a month to see if there is any improvement. One food at a time could then be reintroduced to see if symptoms return. In general, if one chooses to eat these six allergen producing foods, they should be eaten sparingly and no more than once every four to seven days. If allergies persist and there are any problems with swallowing, it would be worthwhile to see a gastroenterologist and consider endoscopy to rule out EoE. Once again Hippocrates is correct in saying “Let your food be your medicine, and let your medicine be your food,” as long as they are the right foods.
2. Wolf WA, Jerath MR, Sperry SL, et al., “Dietary elimination therapy is an effective option for adults with eosinophilic esophagitis.” Clin Gastroenterol Hepatol. 2014 Aug;12(8):1272-9.