Consider Food Allergy Testing in Managing Eosinophilic Esophagitis

David A. Johnson, MD

An integrated approach involving gastroenterologists, nutritionists, and pathologists is recommended.

Food antigens can induce esophageal remodeling with fibrosis, which can resolve with appropriate food antigen elimination. Addressing food allergens in the treatment of eosinophilic esophagitis (EoE) is recommended in a recent guideline (NEJM JW Gastroenterol Jun 7 2013). Although allergy testing is common practice for pediatric gastroenterologists, most adult gastroenterologists are relatively unfamiliar with the practice. The current review provides in-depth guidance, including:

Allergy testing for foods may be more useful in pediatric patients.

The negative predictive values (PVs) of tests for identifiable food allergies are generally higher than positive PVs.

Patients with EoE are often highly atopic and have polysensitization to both food (particularly in children) and aeroallergens (particularly in adults).

Ample evidence supports use of skin-prick or atopy-patch testing for building an elimination diet in children, but not in adults.

Do not utilize food-specific panels using serum immunoglobulin E (or other immunoglobulins) in this setting.

EoE recurs in >90% of pediatric patients after food reintroduction, and only 8% become tolerant of all their food triggers.

Repeat endoscopic biopsy with histologic evaluation after sequential food reintroduction (do not rely on a positive test for food allergy).

Consider the possibility of concurrent allergic diatheses in patients with EoE.

Citation(s):

Aceves SS.Food allergy testing in eosinophilic esophagitis: What the gastroenterologist needs to know. Clin Gastroenterol Hepatol 2013 Sep 11; [e-pub ahead of print].