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June 21, 2007 Role of food allergy in eosinophilic esophagitisSummary Findings - Spergel of the Children's Hospital of Philadelphia reviewed the literature in this area of investigation. He concluded that 3 studies showed that FA, documented by prick and/or patch skin testing, plays a causal role in over 90% of cases of biopsy proven EE. A switch to an elemental diet was followed by significant improvement in over 95% of cases in children while avoidance of prick/patch skin test reactive foods was followed by improvement in over 75% of cases. Empiric elimination of the 6 most common food offenders (regardless of the pattern of skin test reactivity to such foods) was followed by improvement in over 70% of cases. No definitive information is yet available about dietary approaches as to EE in adults. Reference Editor's Comments Although there is not yet a very large amount of study data available, these comments by one of the leading investigators in this area are well worth considering. The diagnostic value of patch testing with a panel of food allergens (in addition to prick skin testing) is being actively investigated. The author (Dr. Spergel) has told me that, in his experience) patch testing with a panel of food allergens elicit positive reactions in about 10% of EE patients when prick skin test responses to such foods are negative. Dr. Spergel has also commented that the commonly recommended treatment of EE with oral fluticasone or budesonide is probably effective in only about 50% of EE cases in children.
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