Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
J Pediatr Gastroenterol Nutr. 2011 Aug;53(2):145-9. doi: 10.1097/MPG.0b013e31821cf503.
Eosinophilic esophagitis (EoE) is an immune-mediated chronic inflammatory disorder triggered by food antigen(s). A 6-food elimination diet (SFED) excluding cow's milk, soy, wheat, egg, peanuts/tree nuts, and seafood has been shown to induce remission in a majority of children with EoE. The goal of the present study was to identify specific food antigens responsible for eosinophilic esophageal inflammation in children with EoE who had achieved histological remission with the SFED.
In this analysis, we retrospectively analyzed children with EoE who completed subsequent single-food reintroductions that led to identification of foods causing disease recurrence. Repeat upper endoscopy with biopsies was performed after single-food introductions. Recurrence of esophageal eosinophilia following a food reintroduction identified that food antigen as a cause of EoE.
A total of 36/46 (25 M/11F) children who were initially successfully treated with SFED completed this trial; the mean age was 7.6 ± 4.3 years. The most common foods identified were 25 to cow's milk (74%), 8 to wheat (26%), 4 to eggs (17%), 3 to soy (10%), and 1 to peanut (6%). Milk was 8 times more likely to cause EoE compared with wheat, the next most common food (95% confidence interval 2.41-26.62, P = 0.0007).
Serial single-food reintroductions following induction of histological remission with the SFED can lead to the identification of specific causal food antigen(s) in EoE. Cow's milk was the most common food identified in subjects with EoE treated with SFED. A subset of children with EoE may develop tolerance to their food sensitivities while on the SFED.
嗜酸性食管炎（EoE）是一种由食物抗原触发的免疫介导的慢性炎症性疾病。6 种食物剔除饮食（SFED）排除了牛奶、大豆、小麦、鸡蛋、花生/坚果和海鲜，已被证明能使大多数 EoE 患儿缓解。本研究的目的是鉴定在接受 SFED 治疗后组织学缓解的 EoE 患儿中，导致嗜酸性食管炎炎症的特定食物抗原。
在这项分析中，我们回顾性分析了完成随后的单一食物重新引入试验的 EoE 患儿，这些重新引入导致了疾病复发的食物的鉴定。在单一食物引入后进行重复上消化道内镜检查和活检。在食物重新引入后出现食管嗜酸性粒细胞增多症的复发，表明该食物抗原是 EoE 的病因。
共有 36/46 名（25 名男性/11 名女性）最初接受 SFED 成功治疗的 EoE 患儿完成了这项试验；平均年龄为 7.6 ± 4.3 岁。最常见的食物是 25 种牛奶（74%）、8 种小麦（26%）、4 种鸡蛋（17%）、3 种大豆（10%）和 1 种花生（6%）。与下一个最常见的食物小麦相比，牛奶引起 EoE 的可能性高出 8 倍（95%置信区间 2.41-26.62，P=0.0007）。
在 SFED 诱导组织学缓解后进行连续的单一食物重新引入试验，可导致在 EoE 中鉴定出特定的致病食物抗原。在接受 SFED 治疗的 EoE 患者中，牛奶是最常见的食物。在接受 SFED 治疗的 EoE 患儿中，有一部分患儿可能会对食物敏感产生耐受性。
