Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain.
J Allergy Clin Immunol. 2013 Mar;131(3):797-804. doi: 10.1016/j.jaci.2012.12.664. Epub 2013 Jan 31.
Although empiric exclusion from the diet of the 6 food groups most likely to trigger allergies achieves eosinophilic esophagitis (EoE) remission in children, data on its prolonged efficacy and effects on adults are lacking.
We sought to evaluate the efficacy of a 6-food elimination diet in inducing and maintaining prolonged remission in patients with adult EoE.
Sixty-seven consecutive patients with adult EoE were prospectively recruited and treated exclusively with a diet avoiding cereals, milk, eggs, fish/seafood, legumes/peanuts, and soy for 6 weeks. Subsequent challenge was undertaken by sequentially reintroducing all excluded single foods, followed by endoscopy and biopsies, which were developed every 6 weeks in case of response (eosinophil peak count reduction to <15/high-power field [hpf]). A food was considered a trigger for EoE and removed from the diet if pathologic eosinophilic infiltration (≥15 eosinophils/hpf) reappeared. Food-specific serum IgE measurements and skin prick tests were performed before initiating the diet.
Forty-nine (73.1%) patients exhibited significantly reduced eosinophil peak counts (<15 eosinophils/hpf) before sequential single-food reintroduction. A single offending food antigen was identified in 35.71% of patients, 2 food triggers were identified in 30.95%, and 3 or more food triggers were identified in 33.3%. Cow's milk was the most common food antigen (61.9%), followed by wheat (28.6%), eggs (26.2%), and legumes (23.8%). Prior allergy tests showed no concordance with food-reintroduction challenge results. All patients who continued to avoid the offending foods maintained histopathologic and clinical EoE remission for up to 3 years.
An empiric 6-food elimination diet effectively induced remission of active adult EoE, which was maintained for up to 3 years with individually tailored, limited exclusion diets.
尽管经验性地排除最有可能引发过敏的 6 种食物组可使嗜酸性粒细胞性食管炎（EoE）患儿缓解，但缺乏其长期疗效和对成人影响的数据。
我们旨在评估 6 种食物剔除饮食在诱导和维持成人 EoE 缓解中的效果。
连续前瞻性招募了 67 例成人 EoE 患者，仅采用避免谷物、牛奶、鸡蛋、鱼/贝类、豆类/花生和大豆的饮食治疗 6 周。随后通过依次重新引入所有剔除的单一食物进行挑战，随后进行内镜检查和活检，如果反应出现（嗜酸性粒细胞峰值计数减少到<15/高倍视野[hpf]），则每 6 周进行一次。如果病理嗜酸性粒细胞浸润（≥15 个嗜酸性粒细胞/hpf）再次出现，则认为食物是 EoE 的触发因素，并从饮食中去除。在开始饮食前进行食物特异性血清 IgE 测量和皮肤点刺试验。
在进行顺序单一食物重新引入之前，49 例（73.1%）患者的嗜酸性粒细胞峰值计数显著减少（<15 个嗜酸性粒细胞/hpf）。在 35.71%的患者中确定了单一的致病食物抗原，在 30.95%的患者中确定了 2 种食物触发因素，在 33.3%的患者中确定了 3 种或更多食物触发因素。牛奶是最常见的食物抗原（61.9%），其次是小麦（28.6%）、鸡蛋（26.2%）和豆类（23.8%）。先前的过敏测试与食物再引入挑战结果无一致性。所有继续避免致病食物的患者在长达 3 年内维持组织病理学和临床 EoE 缓解。
经验性的 6 种食物剔除饮食有效地诱导了活跃的成人 EoE 缓解，通过个体化定制、有限的剔除饮食可维持长达 3 年的缓解。
