Limited usefulness of skin testing to guide dietary interventions in adults with eosinophilic esophagitis (EoE)

A selective elimination diet based on skin testing has shown promising results in large series in children (75% symptomatic and histologic improvement), with high positive (more than 74%) and negative (88% to 100%) predictive values for almost all foods. This study evaluated the data in adults.

A selective elimination diet based on skin testing has suboptimal efficacy for adults with eosinophilic esophagitis (EoE). The usefulness of skin testing for detecting offending foods in adults with EoE is questionable, especially atopy patch tests (APTs).



Eosinophilic Esophagitis (click here to enlarge the image).

Multimodality skin testing (SPT, PPT, APT) did not detect offending foods for adult EoE in 2 of every 3 patients. This study results do not support the development of dietary therapy based exclusively on skin test results for adults with EoE.

Prick-prick tests (PPTs) showed a higher rate of detecting food sensitization compared with SPTs and APTs, and therefore they deserve further consideration in patients with EoE.

The 6-food elimination diet (SFED) looks like a better dietary approach until more accurate food testing or genetic profiling predicting the response to diet are available.

The 6-food elimination diet (SFED) actually incldes 8, not 6 food allergens:

- Wheat
- Dairy (milk products)
- Eggs
- Soy
- Seafood (fish and shelfish) (2 food groups)
- Peanuts and Tree nuts (2 food groups, peanuts are legumes, not nuts)



8 foods cause 90% of food allergies (TEMPS WFS) (click to enlarge the image). The likelihood of a negative oral food challenge is shown in relation to the respective values of skin prick test (SPT) and serum IgE (sIgE).

Hard to Swallow - EOE video by Mayo Clinic: "There is a swallowing disorder that's sending more and more people to see their doctors. It's nickname is E-O-E. It's being reported 30-times more often than it was just 3 decades ago."



References:

Selective elimination diet based on skin testing has suboptimal efficacy for adult eosinophilic esophagitis. The Journal of Allergy and Clinical Immunology, Volume 130, Issue 5 , Pages 1200-1202, November 2012.
http://www.jacionline.org/article/S0091-6749(12)01033-0/fulltext

Food Allergy Testing in Eosinophilic Esophagitis - Medscape, 2014 http://bit.ly/1r6E5W4

Image source: Eosinophilic esophagitis, Wikipedia, GNU Free Documentation License.

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