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How do I know what foods my EOE child is really allergic to?

So you have dragged your child to a GI doctor, the doctors have put a scope down his/her throat and took many biopsies of your child's esophagus and other areas of their gut.  The results are in... that your child has eosinophilic esophagitis or EOE (easier term to remember).  The GI doctor sends you to an allergist as the next step.  Why an allergist? you wonder.  

The Allergist is part of your child's treatment in the way that you might be able to tell what foods "exactly" are causing the uncontrollable eosinophils in your child's throat causing food to get stuck, vomiting and nausea.

There are between 10-15 “common” foods that are well-associated with EoE. These are the foods that are first tested. 

3 Ways to Test for Allergens Causing EOE

Allergy Tests

  •  Skin Prick Testing-  This is done by causing an "angry" surface by scratching a tiny spot  on the skin and then exposing it to a particular food serum.
  • What to expect:  Certain drugs will effect the results of the test such as any antihistamine.  The child should avoid taking any antihistamine for 5 days before the test is done. The test is done in the allergist office and it takes 15 minutes for the results to show up.  The child is not allowed to touch or scratch the area that is being tested.  Afterwards, the results are read by measuring the size of the welt and the size of the redness around the welt.  This doesn't necessarily determine "how" allergic you are, but just that the result is positive.  If the child is allergic to a lot of foods, the testing can become uncomfortable due to itching.  Sometimes the child becomes irritable especially if they are young.
This little boy is allergic to many foods on the skin prick test results
  • Patch Testing-   The patch test is done when the skin prick test is negative and the child has a known EOE diagnosis.  Our GI doctor prefers that we test our girls this way because the patch test is a delayed response to the food and that is how EOE works.  Researchers now know how likely a negative or positive test indicates that one of these particular foods is a trigger for EOE.
  • What to Expect: This is done by putting the food serum on patches and  directly placing them on the skin and leaving it there for 48-96 hours. This will detect any delayed allergic reaction.  The patches are then taken off by the allergist and left to dry for 10-20 minutes.  Results should be able to be seen in that time or even sooner.  Just because there is an irritation on the skin does not mean that the child is allergic to the food.  It does however, help to determine what may be causing the EOE.   Here is my girls being patch tested for 24 foods after 96 hours.  The allergist did not get good results leaving it on the patients for only 48 hours so we decided to experiment with my kids on how long it took to show up.  They were miserable for the 96 hours  and seemed to ask every second if they could take it off.  When the 96 hours were up,  we let the skin dry for the 10 minutes.  On my 7 year old, there were positive results beginning at just 5 minutes from removing the patches.  The spots continued to show up even 20 minutes after we took them off.  My 7 year old was completely negative on her skin prick test however, her patch test was very positive.  I was honestly in a state of shock.  She was positive for the top 4 foods that trigger EOE; milk, wheat, egg and soy.. as well as others like fish and corn.
  • IgE Blood Test-  Blood tests measure the presence of IgE antibodies to specific foods.  IgE, short for “immunoglobulin E,” is the antibody that triggers food allergy symptoms.  This test can help the allergist determine if the child needs to carry an epi-pen with them at all times.  The blood result will be very high if there is a higher chance the child can go into anaphalactic shock.
  • What to expect?   This allergy testing result can take up to a week to come back.  This is depending on what allergens were ordered and whether they have to be sent out to a lab not located in the area. 

Dietary Therapy: There are actually three styles of dietary therapy. Dietary therapy is a form of treatment based on making changes in a person’s diet. All of these dietary therapies are aimed at removing triggers of EOE from the diet.

What you need to know before you start:

  • You need to have completed the Allergy test or tests as listed above.
  • You need to know what foods were positive
  • Elimination diets. Allergy testing is used to determine what foods are likely triggers. Experts recommend that all foods that test positive to are removed from the diet.
  • Elemental diets. An elemental diet is a formula based diet. This special formula does not include any food-based sources of protein. The elemental diet includes only an amino acid formula such as Neocate or Elecare. Simple sugars, salt, oils, and selected fruits may be the only foods allowed on an elemental diet. Some children and adults require a feeding tube to help with these diets.  M

Why choose this diet plan?    When a child is having a hard time getting on the nutrients needed to grow within the normal ranges.  We have chosen this particular diet plan for my daughter.  Currently my 10 year old is on Elecare 4 times daily a long with her regular very restricted diet.  She did not grow in height or weight for 10 months.  She is my child that weighed 12 pounds at 1 year old due to her GI diseases including the EOE (that no doctor was catching)

Because my child doesn't absorb nutrition very well because of the colitis she has as well as the EOE, I really like this multivitamin Supplement for her (found Here).  She can swallow pills but the liquid is absorbed faster and better in her gut.  I highly recommend it.  It is really hard to find a good tasting vitamin supplement for kids, especially that is in liquid form. Sometimes being a mom with a nutrition degree is a hinder because I am so picky when it comes to supplements and foods for my kids.

  • 4- Food Elimination Diet- Newer versions of the 6 food elimination diet have been  simplified to a 4-food elimination of just milk, egg, wheat, and soy.  Source:
  • 6-Food elimination diet. This is a cleverly effective treatment that involves avoiding the 6 major food allergens. These six allergens are milk, egg, wheat, soy, “nuts,” and “seafood.” If you count, it is actually a greater-than-40 food elimination diet when you consider each individual nut or seafood item. This diet can be used without any allergy testing. One study found a 74%  success rate when using this type of nutrition management for EOE. 
  • How do you know if this diet is working? After having an endoscopy, You eliminate the 6 foods for 3 months, then an endoscopy is repeated.  The biopsies taken from both endoscopies are a good indication to the doctor if the elimination diet is working due to the count of eosinophils in the esophagus 
  • 8-Food Elimination Diet-  Using this diet, can mean removing up to the top 8 common allergenic foods. This means no milk, eggs, wheat, fish, peanuts, tree nuts, soy or shellfish.   Depending on the severity of the EOE, some Allergists or Dietitians recommend starting with the 8-food elimination diet and then slowly adding the foods back in every 2-4 weeks and to watch for symptoms to return with those foods.

8-Food elimination diet

FYI on dietary therapy. The good news is that all three diet styles appear to work quite well to get rid of both symptoms and eosinophils. The bad news is that it is not clear which style is the best. No study has directly compared each one in a way that would allow for a true “champion” to be crowned. However, having three choices gives us many options to explore. These three choices allow each provider and family to select an option that works best for them.  For more information on the different diet therapies, go here. 

Dietary therapy may be used as the only therapy for EOE, or it can be combined with medication.

EOE can be frustrating in that it may come and go. EOE is not like an infection that can be treated with antibiotics. It is a lot like asthma, in that it may not go away for several years. However, it may not always be active, either.

Sometimes it is best to meet with a Registered Dietitian to make sure your child is getting the vitamins and minerals needed to grow.  This is the most frustrating part for me as a parent.  Even though I have a bachelors degree in nutrition,  I still can't help my kids enough to grow.  However, this is most of the time due to their pickiness.  Which most kids with EOE tend to be like.


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