Eosinophilic esophagitis (EoE) is a chronic disease characterized clinically by symptoms of esophageal dysfunction and histologically by eosinophil-predominant inflammation. EoE is frequently associated with concomitant atopic diseases and immunoglobulin E (IgE) sensitization to food allergens in children as well as to aeroallergens and cross-reactive plant allergen components in adults. Patients with EoE respond well to elemental and empirical food elimination diets. Recent research has, however, indicated that the pathogenesis of EoE is distinct from IgE-mediated food allergy. In this review, we discuss the individual roles of epithelial barrier defects, dysregulated innate and adaptive immune responses, and of microbiota in the pathogenesis of EoE. Although food has been recognized as a trigger factor of EoE, the mechanism by which it initiates or facilitates eosinophilic inflammation appears to be largely independent of IgE and needs to be further investigated. Understanding the pathogenic role of food in EoE is a prerequisite for the development of specific diagnostic tools and targeted therapeutic procedures.Abbreviations ACD, allergic contact dermatitis; AD, atopic dermatitis; APT, atopy patch test; DHR, drug hypersensitivity reactions; EoE, eosinophilic esophagitis; FPIES, food protein-induced enterocolitis; GERD, gastroesophageal reflux disease; GI, gastrointestinal; IBD, inflammatory bowel disease; Ig, immunoglobulin; OAS, oral allergy syndrome; PPI-REE, proton pump inhibitor-responsive esophageal eosinophilia; SFED, six-food elimination diet; SPT, skin prick test; TCR, T-cell receptor; TNF, tumor necrosis factor.Allergy 71 (2016) 611-620