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Comparative dietary therapy effectiveness in remission of pediatric eosinophilic esophagitis
Open accessAbstract
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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Eosinophilic esophagitis: Updated consensus recommendations for children and adults
Liacouras, C. A., Furuta, G. T., Hirano, I., Atkins, D., Attwood, S. E., Bonis, P. A., Burks, A. W., Chehade, M., Collins, M. H., Dellon, E. S., et al. (2011) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2011.02.040 · Cited by 2,073
Self-citationFuruta, G. T., Liacouras, C. A., Collins, M. H., Gupta, S. K., Justinich, C., Putnam, P. E., Bonis, P., Hassall, E., Straumann, A., & Rothenberg, M. E. (2007) · Gastroenterology · doi:10.1053/j.gastro.2007.08.017 · Cited by 1,673
Self-citationUtility of food-specific IgE concentrations in predicting symptomatic food allergy
Sampson, H. A. (2001) · Journal of Allergy and Clinical Immunology · doi:10.1067/mai.2001.114708 · Cited by 1,362
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Eosinophilic Esophagitis: A 10-Year Experience in 381 Children
Liacouras, C. A., Spergel, J. M., Ruchelli, E., Verma, R., Mascarenhas, M., Semeao, E., Flick, J., Kelly, J., Brown–Whitehorn, T., Mamula, P., et al. (2005) · Clinical Gastroenterology and Hepatology · doi:10.1016/s1542-3565(05)00885-2 · Cited by 872
Eotaxin-3 and a uniquely conserved gene-expression profile in eosinophilic esophagitis
Blanchard, C. (2006) · Journal of Clinical Investigation · doi:10.1172/jci26679 · Cited by 870
Effect of Six-Food Elimination Diet on Clinical and Histologic Outcomes in Eosinophilic Esophagitis
Kagalwalla, A. F., Sentongo, T. A., Ritz, S., Hess, T., Nelson, S. P., Emerick, K. M., Melin–Aldana, H., & Li, B. U. K. (2006) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2006.05.026 · Cited by 732
An etiological role for aeroallergens and eosinophils in experimental esophagitis
Mishra, A., Hogan, S. P., Brandt, E. B., & Rothenberg, M. E. (2001) · Journal of Clinical Investigation · doi:10.1172/jci10224 · Cited by 626
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Cited by
Food allergy: A practice parameter update—2014
Sampson, H. A., Aceves, S., Bock, S. A., James, J., Jones, S., Lang, D., Nadeau, K., Nowak-Wegrzyn, A., Oppenheimer, J., Perry, T. T., et al. (2014) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2014.05.013 · Cited by 845
Review article: the diagnosis and management of food allergy and food intolerances
Turnbull, J. L., Adams, H. N., & Gorard, D. A. (2015) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.12984 · Cited by 306
High prevalence of eosinophilic esophagitis in patients with inherited connective tissue disorders
Abonia, J. P., Wen, T., Stucke, E. M., Grotjan, T., Griffith, M. S., Kemme, K. A., Collins, M. H., Putnam, P. E., Franciosi, J. P., von Tiehl, K. F., et al. (2013) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2013.02.030 · Cited by 195
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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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