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- Title
Efficacy of Ig E-targeted vs empiric six-food elimination diets for adult eosinophilic oesophagitis.
- Authors
Rodríguez-Sánchez, J.; Gómez Torrijos, E.; López Viedma, B.; de la Santa Belda, E.; Martín Dávila, F.; García Rodríguez, C.; Feo Brito, F.; Olmedo Camacho, J.; Reales Figueroa, P.; Molina-Infante, J.
- Abstract
Background Skin testing-guided elimination diet has proved unsuccessful for adult eosinophilic oesophagitis ( Eo E), whereas empiric six-food elimination diet ( SFED) achieves an efficacy of 70%. Objective To compare the efficacy of food-specific serum Ig E-targeted elimination diet ( sIgE- ED) and SFED. Methods Prospective study in adult patients with Eo E. Food-specific serum Ig E, skin prick test ( SPT) and atopy patch test ( APT) to foods included in SFED were performed. Those with ≥1 positive IgE test, defined by ≥0.1 kU/l, followed a 6-week sIgE- ED, whereas non-IgE-sensitized patients underwent a 6-week SFED. Responders to diet (<15 eos/HPF) underwent individual reintroduction of foods followed by histological assessment. Results Forty-three EoE patients were included (26 sIgE- ED and 17 SFED). Regarding sIgE- ED, the mean number of eliminated foods per patient was significantly lower than in SFED (3.81 vs 6; P < 0.001), being wheat (85%), nuts (73%) and cow's milk (61%) the most commonly foods withdrawn. No difference in histological response was observed between sIgE- ED and SFED (73% vs 53%, P = 0.17). Causative foods identified by food challenge were cow's milk (64%), wheat (28%), egg (21%) and legumes (7%), with a single food trigger in 71% of patients. sIgE exhibited the higher accuracy to predict offending foods in IgE-sensitized patients (sensitivity 87.5%, specificity 68% ( κ = 0.43)), with k values of 1 for cow's milk. APT results were all negative. Conclusions Histological remission was accomplished in 73% of patients undergoing sIgE-ED, which was nonsignificantly superior to SFED. sIgE effectively identified cow's milk as a food trigger in IgE-sensitized patients.
- Subjects
EOSINOPHILIC esophagitis; IMMUNOGLOBULIN E; SKIN; DISEASES in adults; HISTOLOGY; THERAPEUTICS
- Publication
Allergy, 2014, Vol 69, Issue 7, p936
- ISSN
0105-4538
- Publication type
Article
- DOI
10.1111/all.12420