CHOC Children's - Food Elimination

Eosinophilic Esophagitis Clinic :: Food Elimination

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Research has shown a strong connection between food allergies and eosinophilic esophagitis (EoE). Studies have shown that particular foods cause allergy cells to build up in the esophagus. While there are certain foods that are common EoE culprits, there is no way of knowing for sure which foods trigger EoE in a patient without allergy testing and eliminating foods from a child’s diet.

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Directed Elimination Diet
After a child has completed a full allergy work-up, our multidisciplinary EoE team uses the information from both the skin prick test and patch test to develop a directed elimination diet in which all foods the child tests positive to will be eliminated from his or her diet. The goal is to eliminate the food(s) that may be causing the eosinophils to travel to the esophagus. Because it takes time for the esophagus to heal, patients typically follow the diet for at least eight weeks. Allergy testing is not 100% accurate, and some of the foods that may be positive on testing may not be causing a child’s EoE. Our team cannot positively know what foods are causing the EoE until we see a change in the amount of allergy cells inside the esophagus.

Severly Restricted Diet
Some children may test positive to multiple foods which are subsequently eliminated from the child's diet or may be following the 6-food elimination diet with additional foods that were positive from allergy testing. These types of diets are considered severely restricted diets because of the amount of foods that are eliminated from the patient's diet. Should this be the case, the child’s dietitian will provide detailed information on how to follow the diet and a variety of resources about available food options to ensure the child’s nutritional needs are met. An elemental formula may also be prescribed in combination with an elimination diet if it is not possible to meet nutritional requirements with an elimination diet and/or if the child has poor growth and/or weight loss.

Learn more about elimination diet meal planning with our special guides.

6-food Elimination

Children placed on the 6-food elimination typically do not test positive for allergies with the skin prick test or patch test. This diet requires families to remove the top-known food allergens from a child’s diet. These foods are:

Milk
Egg
Wheat
Soy
Fish and shellfish
Tree nuts & peanuts

Research published in the journal Clinical Gastroenterology and Hepatology has shown that 74% of children who follow this diet see their EoE symptoms disappear.

Because this diet eliminates common foods that provide children with the nutrients they need to grow and be healthy, our registered dietitian closely monitors each child to make he or she is getting the right nutrition.

Tips for Preparing Meals for Children on Elimination Diets

Beyond Elimination Diets

If the elimination diets do not help with the child's EoE symptoms, we may recommend putting the child on an elemental formula diet in which all food is removed from the child's diet. Learn more about the elemental diet.
Approximately eight weeks after starting a diet, we will perform another endoscopy to see if the child's eosinophils have improved. If the child's scope is clean, he or she may then begin to have food reintroduced into his or her diet under the direction of the child's nurse practitioner or physician at the Eosinophilic Esophagitis Clinic. Learn more about food reintroduction.
Some children may require medical management of their EoE symptoms with medications. Learn more about medical management of EoE.

Elimination diets are supervised by the child's medical team and should not be attempted unless prescribed by the child's EoE specialist.