Table 2 Characteristics of dietary approaches in the treatment of pediatric eosinophilic esophagitis
From: Pediatric eosinophilic esophagitis: a review for the clinician
Dietary approach | Definition | Indication | Success rate | Advantages | Disadvantages |
|---|---|---|---|---|---|
Elemental diet | Diet consisting of amino acid-based formula | In patients with multiple allergies, growth stop, severe disease unresponsive to therapy or unable to follow a highly restrictive diet | 90% | Allergen-free Nutritionally complete | Taste (feeding tube could be needed) Expensive Age relevance Elimination of all foods Negative impact on the quality of life |
Empiric elimination diet or six-food elimination diet | Elimination of “big six” major food allergens from the diet (milk, egg, wheat, soy, peanut/tree nut, and fish/shellfish) | In the absence of specific allergic sensitization to foods | 72% | Allergy testing not needed | Several eliminations could be unnecessary Only four foods may be essential Expensive Nutritional deficiency |
Targeted diet | Elimination of foods with a positive response to allergy testing | Strongly suspected food allergy based on the clinical history and positive allergy testing | 45–77% | Food specificity Nutritional preservation | Different testing precision and technique among centers Low negative predictive value of milk testing Unnecessary avoidance if sensitization without clinical allergy |