Eosinophilic Esophagitis (EoE) is a chronic immune-mediated condition that affects the oesophagus, leading to inflammation, difficulty swallowing, and other gastrointestinal symptoms.

Dietary elimination is a key treatment strategy for paediatric patients, but traditional six-food elimination diets (SFED or 6FED) can be challenging to follow and significantly impact the quality of life (QoL).

6FED removes milk, egg, wheat, soy, nuts, and seafood, which is often effective but can be restrictive, socially isolating, and nutritionally challenging for growing children.

This study, published in the Journal of Allergy and Clinical Immunology, aimed to assess whether a less restrictive approach (eliminating only one major trigger food, milk) or four common allergens (milk, egg, wheat, soy) could provide similar symptom relief and histologic improvement while being easier to maintain. 

Methods

The study enrolled patients aged 6 to 17 with histologically confirmed and symptomatic EoE. Participants were randomised 1:1 to either the 1FED, which eliminated only milk, or the 4FED, which excluded milk, egg, wheat, and soy. The dietary intervention lasted for 12 weeks.

The primary endpoint was symptom improvement, assessed using the Pediatric Eosinophilic Esophagitis Symptom Score (PEESS). Secondary endpoints included histologic remission (<15 eosinophils per high-power field); change in histologic features (histology scoring system), endoscopic severity (endoscopic reference score), transcriptome (EoE diagnostic panel), and QoL scores; and predictors of remission.

Results

The findings suggest that while 4FED led to slightly better symptom improvement, both diets had similar histologic, endoscopic, QoL, and transcriptomic outcomes. These results highlight the potential of 1FED as a simpler, more tolerable first-line dietary therapy for paediatric EoE, offering a balance between treatment efficacy and the daily challenges faced by children and their families.

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Reference:

Kliewer, K. L., Abonia, J. P., Aceves, S. S., Atkins, D., Bonis, P. A., Capocelli, K. E., Rothenberg, M. E. (2024). One-food versus four-food elimination diet for pediatric eosinophilic esophagitis: A multisite randomized trial. Journal of Allergy and Clinical Immunology. Retrieved from https://www.jacionline.org/article/S0091-6749(24)00907-2/abstract

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