Nutritional impact of dietary therapy in pediatric eosinophilic esophagitis

Published Online: September 1, 2014

Eosinophilic esophagitis (EoE) is a medical disorder characterized by massive infiltration of the esophagus by eosinophils. The illness is typically related to food allergies. Dietary therapy involving the elimination of commonly allergenic foods such as cow’s milk, wheat, egg, soy and others is the mainstay of treatment. However, the impact of this dietary therapy on nutritional parameters in children with EoE has not been extensively characterized.

Recently published in The Journal of Allergy and Clinical Immunology: In Practice, Colson and colleagues present a retrospective study of a convenience sample of EoE patients referred to their pediatric gastroenterology practice in France. The study focused on 59 children with data collected over 2 months of dietary therapy (including avoidance of the 6 most common allergenic foods, plus avoidance of foods eliciting positive allergy skin tests, and including an amino-acid formula (AAF) as replacement for dairy products). They evaluated pre- and post-diet allergic and nutritional status.

The participants were a median age of 78 months (range, 9 to 189 months).  Dietary therapy induced a significant return to normal endoscopic appearance in 47% of cases and evolution to complete remission (<5 eosinophils seen per microscopic high power field and disappearance of symptoms) for 59 % of cases. Ten percent of children presented initially with moderate malnutrition before treatment. After 2 months of dietary therapy, median weight-for-height improved slightly, but without reaching statistical significance. Follow-up after 1 year of progressive reintroduction of eliminated food was available in 33 children and was associated with mild nutritional improvement which was also not statistically significant. The authors concluded that the nutritional status of the children was mildly affected by EoE, and was not worsened by a 2-month period of dietary therapy.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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