Food allergy and eosinophilic esophagitis.

PURPOSE OF REVIEW: Eosinophilic esophagitis (EoE) is a chronic allergic disease of the esophagus. A mix of immediate, IgE-mediated and delayed, non-IgE-mediated immunological reactions to foods is thought to play a role in EoE. Our purpose is to review available clinical and research evidence for this link between food allergy and EoE.

RECENT FINDINGS: Various food elimination trials resulted in various rates of disease remission. Exclusive amino acid formula-based dietary trials resulted in more than 90% remission in children with EoE. Empiric elimination diets consisting of avoidance of foods commonly known to cause hypersensitivity reactions resulted in 50-74% disease remission. When diets were tailored based on results from skin prick and atopy patch tests, remission rates were comparable. Translational research studies performed on esophageal tissues and peripheral blood of patients with EoE demonstrated an allergic T-helper type 2 phenotype, though mechanisms linking the disease to food allergens are not fully addressed.

SUMMARY: Foods appear to be important allergic triggers in EoE. Identification of these triggers, however, remains a challenge. Research is needed to elucidate at which point in the pathogenesis of EoE foods become important so that their role can be better understood, and develop better tests to identify these foods.