Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests

Spergel, Jonathan M.; Andrews, Tom; Brown-Whitehorn, Terri F.; Beausoleil, Janet L.; Liacouras, Chris A.

doi:10.1016/s1081-1206(10)61151-9

Cited by 423 publications

(334 citation statements)

References 22 publications

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“…Notably, practically similar treatment options were used in the management of EoE subjects at the center 31, 34, 40, 41, 51. Two studies published from another US center, although with different treatment options and study design, used two different criteria to define histological remission 26, 52…”

Section: Resultsmentioning

confidence: 99%

Systematic review of histological remission criteria in eosinophilic esophagitis

Eke

White

et al. 2018

JGH Open

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Elemental diets, dietary elimination, and steroid therapies are the most common therapies in the clinical trials for eosinophilic esophagitis (EoE). Histological findings (usually reported as eosinophils per microscopic high‐powered field [hpf]) remain the most common end‐point used to define response. Yet, the threshold for defining “response” and “remission” are ill‐defined among consensus guidelines and may vary from study to study. We conducted a systematic literature review of articles on eosinophilic esophagitis, published between January 2007 and November 2017, considering histological remission as the primary outcome. We abstracted treatment information and definitions of histological remission or response. A comparison of definitions of histological remission across and within institutions was performed. A total of 61 articles were included in this review, with approximately 60% of the studies published from centers in the United States. Histological definitions of remission of EoE ranged from 0 to ≤20 eosinophils/hpf. The most stringent criteria, ranging from 0 to ≤5 eosinophils/hpf, were commonly used in interventional trial studies that examined the effects of new treatments. We found remarkable variability in definitions between studies, treatment types, and regions. Age or epidemiological distribution of study subjects did not influence the criteria for histological remission. Clinical and histological improvements are important measures of the effects of treatment. Histological findings, the most objective measure of treatment, should provide an optimal method for comparing the effectiveness of various treatments. Yet, our findings suggest a lack of consistent remission criteria in published studies. Considering these inconsistencies, it is difficult to compare the effectiveness of various treatments.

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Section: Resultsmentioning

confidence: 99%

Systematic review of histological remission criteria in eosinophilic esophagitis

Eke

White

et al. 2018

JGH Open

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“…In studies on children, only a single research group achieved EoE remission after excluding foods for which patients had demonstrated sensitization in SPT and atopic patch tests (APT) [24].…”

Section: Allergy Study Results In Eoe Patientsmentioning

confidence: 99%

“…Further studies focused on identifying and subsequently restricting from the diet those foods, which specifically triggered EoE after being identified through allergy testing. Thus, satisfactory results were obtained in 2005 after using SPT and APT in a pediatric EoE series; in these subjects an average of five foods had to be restricted [24] in order to maintain disease remission. However, when other researchers tried to reproduce these results in both children and adults [77], they failed, probably because APTs are not standardized tests.…”

Section: Dietary Therapiesmentioning

confidence: 99%

“…The slightly lower efficacy observed in children treated with swallowed inhaled steroids is probably due to difficulties in coordinating the 'push and swallow' sequence; this drawback has largely been overcome through the use of viscous liquid formulas. It is also interesting to note that the various available dietary interventions for EoE produce similarly effective results in children and adults, ranging from 88 to 70% [10,24,29,78,80,81]. It is thus clear that in approximately three out of four EoE patients, the disease is triggered and maintained exclusively by food, with the remaining quarter of cases attributable to air-borne allergens, either alone or together with food allergies.…”

Section: Expert Commentary: Unresolved Aspects and Proposed New Researcmentioning

confidence: 99%

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Adult versus pediatric eosinophilic esophagitis: important differences and similarities for the clinician to understand

Lucendo

Sánchez-Cazalilla

2012

Expert Review of Clinical Immunology

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“…Eliminating foods in children with EoE based on allergy testing with both skin prick and atopy patch testing showed a 77% improvement in symptoms and esophageal inflammation on follow-up. Egg, milk, soy, corn and wheat were identified most frequently between the groups as food allergens [75]. However the use of skin prick testing alone only predicted 13% of foods associated with EoE [76].…”

Section: Dietary Treatmentmentioning

confidence: 97%

Eosinophilic Esophagitis–More than Two Decades of Progress

Rahimi

Ertan

2015

JGPLD

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Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests

Cited by 423 publications

References 22 publications

Systematic review of histological remission criteria in eosinophilic esophagitis

Systematic review of histological remission criteria in eosinophilic esophagitis

Adult versus pediatric eosinophilic esophagitis: important differences and similarities for the clinician to understand

Eosinophilic Esophagitis–More than Two Decades of Progress

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