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The six-food elimination diet shows eggs and dairy most common allergy triggers

How allergic is your esophagus to specific foods if those foods irritate your esophagus or are the root cause of your acid reflux? Could you have eosinophilic esophagitis? Do you need to stop eating the six foods causing the most food allergies? The six-food elimination diet is about eliminating dairy, wheat, eggs, soy, nuts and seafood. Eggs and dairy were found to be the most common triggers, both impacting 44 percent of patients in this new study. In the research, scientists suggested that adults with eosinophilic esophagitis should consider a diet change. Dietary elimination is a successful method of treatment for adults with eosinophilic esophagitis (EoE), according to that new study, "Dietary Elimination Therapy Is an Effective Option for Adults With Eosinophilic Esophagitis," recently appearing online in Clinical Gastroenterology and Hepatology, the official clinical practice journal of the American Gastroenterological Association. Authors are Wolf et al.

The six-food elimination diet shows eggs and dairy most common allergy triggers.
Photo by Scott Olson/Getty Images

Food allergy led to the discovery of eosinophilic esophagitis. Your esophagus could be allergic to certain foods that cause a wide variety of symptoms affecting your esophagus, including some types of acid reflux, irritation, and other symptoms, and in a new study dietary changes helped the patients. You also may wish to check out related videos on YouTube. Or see the recent study, "Efficacy of Dietary Interventions for Inducing Histologic Remission in Patients With Eosinophilic Esophagitis: A Systematic Review and Meta-analysis. Gastroenterology," also recently published in Clinical Gastroenterology and Hepatology.

"By eliminating specific foods from patients' diets, symptoms improved in 71 percent of patients, and endoscopic appearance improved in 54 percent," said lead study author, W. Asher Wolf, MD, MPH, and co-author Evan S. Dellon, MD, MPH, according to the July 18, 2014 news release, "Adults with eosinophilic esophagitis should consider a diet change." Wolf and Dellon are from the division of gastroenterology and hepatology, University of North Carolina School of Medicine. "These strong results support dietary elimination therapy as an effective treatment for adults suffering from EoE."

Researchers conducted a retrospective cohort study using the University of North Carolina EoE database from 2006-2012. Subjects were 18 years of age or older and diagnosed with EoE based on consensus guidelines.

Eosinophilic esophagitis is a chronic immune system disease caused by a buildup of white blood cells in the lining of the esophagus. This build up, which is a reaction to food, allergens or acid reflux, can inflame or injure esophageal tissue, making swallowing and eating a challenge for patients.

The study analyzed two diet elimination plans

For the first therapy — targeted elimination — patients underwent evaluation with skin prick testing, and foods that had a positive reaction, as well as any foods identified by patient self-report as being possible triggers regardless of the severity of response, were eliminated. For the other diet prescribed — the six-food elimination diet — dairy, wheat, eggs, soy, nuts and seafood were eliminated from the patient's diet regardless of skin-prick test results.

Sixty-eight percent of patients who received targeted diet elimination experienced symptom improvement, compared with 78 percent of those who followed a six-food elimination diet plan. For those subjects who responded to six-food elimination diet, one food (or food group) was added back every six weeks, and endoscopy was repeated.

Eggs and dairy were found to be the most common triggers, both impacting 44 percent of patients

This is important, because this study included patients who failed steroid therapy, the overall study population likely represents harder to treat EoE patients. The success of dietary elimination in this population indicates its utility for therapy in patients resistant to steroids.

Because EoE is an allergen/immune mediated condition, dietary elimination therapy has been extensively studied in children and is now a well-established modality in pediatric patients. Until recently, the utility of dietary elimination was unknown in adults. However, evidence is mounting; a June 2014 Gastroenterology meta-analysis2 reported that dietary interventions are effective in producing histologic remission in both pediatric and adult patients with EoE.

While the current treatment of swallowed corticosteroids acts topically to reduce esophageal inflammation, no corticosteroid is FDA approved, not all patients respond and, when discontinued, EoE almost always recurs. As such, there is a growing need for a new treatment for patients with EoE. Further research should emphasize which factors can predict effective dietary therapy, to target therapy to patients most likely to respond. You also may be interested in the letter, "Genome-wide association analysis of eosinophilic esophagitis provides insight into the tissue specificity of this allergic disease."

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