Q:

6/28/2013
I am following several patients with eosinophilic esophagitis and trying empiric 6 food elimination diets on a few of them. During the re-introduction phase of foods, one by one, if a patient has an adverse reaction of any kind, what would you suggest would be the recommended waiting time after the reaction before introducing the next food? One paper I saw mentioned a 6 week washout period (Gonsalves et al. Gastroenterology, 2012:142:1451-9) but this was in view of repeating endoscopy. In my practice center, it is not feasible for endoscopies to be done as often as was presented in that paper, so I am wondering if 1 or 2 weeks would be considered adequate if there is resolution of clinical symptoms within that time. Thanks for your insights.

A:

Thank you for your inquiry.

I am going to ask Dr. Anne Ditto, an allergist/immunologist who participated in the trial you mentioned where Dr. Gonsalves was the lead author, to assist us with your inquiry. As soon as we receive a response from Dr. Ditto, we will forward it to you.

Thank you again for your inquiry.

Sincerely,
Phil Lieberman, M.D.

We received a response from Dr. Anne Ditto. Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Anne Ditto:
There are no good data on how long to wait to reintroduce food after a patient reacts to a food introduced after food elimination. What makes this more complicated is symptoms don't always correlate with disease seen on endoscopy. In addition, it is still not clear what kind of allergic reaction we are dealing with and so recovery time is not known (unless the reaction is clearly an IgE mediated reaction such as hives, angioedema etc.) I think, however, in clinical practice, where it is understandable that frequent endoscopies are not feasible, following symptoms is reasonable and waiting 1-2 weeks after symptom resolution also seems reasonable. Should it appear however that the patient then continues to react to subsequent foods introduced, it may be that the initial reaction has not fully resolved and a longer recovery time may be needed.

Please let me know if I can be of further assistance.

Sincerely,
Anne Ditto

AAAAI - American Academy of Allergy Asthma & Immunology