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Comparative dietary therapy effectiveness in remission of pediatric eosinophilic esophagitis

Open access
Henderson, Carol J., Abonia, J. Pablo, King, Eileen C., Putnam, Philip E., Collins, Margaret H., Franciosi, James P., Rothenberg, Marc E.·2012·Journal of Allergy and Clinical Immunology

Abstract

Background Eosinophilic esophagitis is a chronic, immune-mediated inflammatory disorder that responds to dietary therapy; however, data evaluating the effectiveness of dietary therapeutic strategies is limited. Objective This study compared the effectiveness of three frequently prescribed dietary therapies [elemental, six-food elimination, and skin prick and atopy patch-directed elimination] and assessed the remission predictability of skin tests and their utility in directing dietary planning. Methods A retrospective cohort of proton-pump inhibitor-unresponsive, non-glucocorticoid-treated eosinophilic esophagitis patients who had two consecutive endoscopic biopsies associated with dietary intervention was identified. Biopsy histology and remissions (< 15 eosinophils/high-power field) following dietary therapy and food reintroductions were evaluated. Results Ninety-eight of 513 patients met eligibility criteria. Of these 98, 50% (49), 27% (26), and 23% (23) received elemental, six-food elimination, and directed diets, respectively. Remission occurred in 96%, 81%, and 65% of patients on elemental, six-food elimination, and directed diets, respectively. The odds of post-diet remission vs. non-remission were 5.6-fold higher (P=0.05) on elemental vs. six-food elimination, 12.5-fold higher (P=0.003) on elemental vs. directed, and were not significantly different (P=0.22) on six-food elimination vs. directed diets. Following 116 single-food reintroductions, the negative predictive value of skin testing for remission was 40%–67% (milk 40%, egg 56%, soy 64%, and wheat 67%). Conclusion All three dietary therapies are effective; however, an elemental diet is superior at inducing histologic remission compared with six-food elimination and skin test-directed diets. Notably, an empiric six-food elimination diet is as effective as a skin test-directed diet. The negative predictive values of foods most commonly reintroduced in single-food challenges are not sufficient to support the development of dietary advancement plans solely based on skin tests.

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Metadata

Authors
Henderson, C. J., Abonia, J. P., King, E. C., Putnam, P. E., Collins, M. H., Franciosi, J. P., & Rothenberg, M. E.
Venue
Journal of Allergy and Clinical Immunology
Publisher
Elsevier BV
Published
2012-06
Volume
129
Issue
6
Pages
1570-1578
ISSN
0091-6749 (ISSN-L)
OpenAlex
W1973716304
Cited by
275
References
38
FWCI
30.37
Type
journal article
Language
en
Open access
green

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CoChat. (2026). Citation check: Comparative dietary therapy effectiveness in remission of pediatric eosinophilic esophagitis. https://app.cochat.ai/papers/10.1016/j.jaci.2012.03.023
The paper
Henderson, C. J., Abonia, J. P., King, E. C., Putnam, P. E., Collins, M. H., Franciosi, J. P., & Rothenberg, M. E. (2012). Comparative dietary therapy effectiveness in remission of pediatric eosinophilic esophagitis. Journal of Allergy and Clinical Immunology. https://doi.org/10.1016/j.jaci.2012.03.023

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

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