This summary was compiled from the tweets posted by allergists/immunologists who attended the 2013 annual meeting of the American Academy of Allergy Asthma and Immunology (AAAAI) (see the list at the end). The tweets were labeled #AAAAI. The text was edited and modified by me.Dr. Aceves discussed Eosinophilic esophagitis (EoE). There was a recent Practice Parameter on EoE in 2011 JACI.
EoE is a clinopathological diagnosis requiring 15 eos/hpf to confirm diagnosis. We must distinguish EoE from PPI respondent EE (esophageal eosinophilia).
Clinical symptoms with EoE vary by age. Younger patients present with more vomiting, eating disorder, and failure to thrive. Older patients present more with food impaction.
Eosinophilic Esophagitis (click here to enlarge the image).
Diet works in EoE
Elemental formula is highly effective in treating EoE. There is a good evidence that foods play a role. The most common food triggers in EoE are milk, wheat egg, soy, grains, legumes, meats.
Elemental diet in adult EoE patients leads to pathological improvements in as little as 2-4 weeks. Multiple studies show elemental diet helps in treatment of EoE in children. Aceves reviewed the Peterson study in 2013 AJG showing that elemental diet is also helpful in adults but there is a big difference in adherence to the diet.
Elimination diet options includes food testing based or 6 (really 8) food elimination diet. Milk is the most significant trigger in children.
Resolution rates of EoE on empiric elimination diet are 50-81% in various studies.
Milk is a problem in EoE
Cows milk and wheat seem to be frequent triggers in EoE in both adults and children. In both kids and adults when foods are reintroduced the most common EoE triggers are: milk and wheat.
Directed elimination diet (SPT and APT) plus milk elimination leads to 77% resolution.
PPV of patch testing for food in EoE is 44%. SPT was 13% at best. 15-24% of EoE pts have a history of food anaphylaxis also.
EoE food testing: combining prick and patch test has PPV 44%, NPV as high as 92% (except milk 44%).
Dr Aceves is pondering more of a 4 food elimination diet (milk, egg, wheat and soy) as these appear to be the most common EoE triggers (rather than 6 food elimination diet).
Data presented in the TIGERS conference (focused on GI diseases with eosinophilia) suggested that milk elimination did not necessarily have to rule out drinking extensively heated milk in EoE.
A guide to successfully managing Eosinophilic Esophagitis in Q&A format from APFED http://goo.gl/0l9PX:
Allergists are on Twitter - follow them
Allergists increased Twitter use 470% in one year - 25 allergists reached 250,000 individuals from the 2012 #AAAAI meeting (see the references here). This summary was compiled from some of the tweets posted by the following allergists:
https://twitter.com/ananth720
https://twitter.com/IgECPD
https://twitter.com/mrathkopf
This is a list of the allergists who used Twitter to post updates from the 2013 #AAAAI meeting. The list is open for edit, please feel free to add your own info.
I would strongly encourage you to post updates on Twitter from the CME conferences that you are planning to attend in the future. Here is how to do it: Twitter for Physicians: How to use Twitter to keep track of the latest news and scientific meetings, and share information with colleagues and patients.
Disclaimer: The text was edited, modified, and added to by me. This is one of a series of posts that will be published during the next few weeks.
Comments from Twitter:
@PedNutritionGuy: Excellent synopsis of Eo #esophagitis #nutrition updates from 2013 #AAAAI meeting goo.gl/YwrEo #RDchat #allergy