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Eosinophilic Esophagitis (EoE) is a condition that is gaining more and more recognition. Unfortunately though, the treatment options for EoE are not black and white. EoE may be treated either with medication, which has known long term side effects, or nutrition therapy, which has been shown extremely effective, but may be hard to follow for some.

Medication treatment for EoE is the use of steroids. However, this is not a long term fix. As EoE is a chronic condition, treatment with nutrition therapy is often discussed. Here are nutritional therapy options for EoE:

• Elemental Diet – A diet consisting of solely an amino acid-based (or elemental) products
• Elimination Diets – The removal of allergens from the diet.
  1. Tailored Elimination – Elimination of specific allergens based on allergy testing
  2. Six Food Elimination – Elimination of 6 top allergens based on the most common allergens seen in EoE patients

The Six Food Elimination Diet

The 6 Food Elimination diet is interesting because it bypasses the need of extensive food allergen testing. As you may know, allergy testing (skin prick tests and blood tests) are not perfect. There are often false positives which can make the treatment plan more complicated and time consuming. So what the 6 Food Elimination diet proposes is that, off-the-bat, patients will eliminate the top 6 allergens seen in EoE patients. The top allergens are milk, soy, eggs, wheat, peanuts/tree nuts, and seafood. One study¹ confirms there is a 74% success rate when using this type of nutrition therapy for EoE. (As a point of reference, an Elemental Diet shows a 95-98% success rate based on multiple studies)

Advantages and Disadvantages to consider

The advantages of using this nutrition therapy are that the EoE patients may still eat solid foods. It also eliminates the need for extensive skin and blood tests to check for food allergies. Important disadvantages to this diet therapy are that it may unnecessarily remove foods from the diet. This could increase the risk of the patients’ nutritional status. As some of you may know, it is hard just to remove milk and soy from your diet. Try eliminating 6 different allergens while maintaining your nutritional status! One way to ensure there are no risks for nutritional deficiencies is to supplement the diet with a nutritionally dense, hypoallergenic elemental product, such as Neocate®. This will help ensure the patient is getting all the protein and nutrients they need per day while guaranteeing that no allergic reactions will occur upon starting the elemental products. It is vital that EoE patients are monitored by a dietitian. The dietitian will help calculate how much of the elemental product the patient will need per day and also make sure the nutritional status of the patient is maintained.

Again, since there is a 74% success rate, if any symptoms persist after starting the 6 Food Elimination diet, see your doctor, as you may need a more “allergen safe” diet therapy such as an Elemental diet.

I hope this helped to shed some light on this nutritional therapy option for EoE. Every person will have their own treatment plan that works for them. Is anyone doing an Elimination diet now? How is it going for you? Have any tips you can share that may help others manage an elimination diet?

-Christine

^{1 Kagawalla AF et al, Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006:4(9):363-8}

In a very recent study looking at the prevalence, diagnosis, and management of food allergies, it found that “the evidence for the prevalence and management of food allergy is greatly limited by a lack of uniformity for criteria for making a diagnosis.”¹ Interestingly, the study also stated that there is not a universally accepted definition of food allergy!¹

There are several food allergy tests out there to make a diagnosis of a food allergy. It can be difficult sometimes to determine which one will help get the most accurate diagnosis for you or your little one. Today we will cover what the most common tests are and how they work.

The most common allergy diagnosis tests are skin prick testing, total serum (blood) IgE testing, and atopic patch testing. An oral food challenge is also an effective test for food allergy diagnosis, but it has its limitations.

Here is a list of how each test works and some of the advantages and disadvantages of each one. Some of these tests can be less accurate in young children, so remember to talk with your doctor about which option(s) is best for your child.

Skin Prick Tests (SPT) – Direct challenge of allergen on skin with a needle prick. Most commonly used method.

Advantages: Rapid results, may apply many allergens, easy to perform.²

Disadvantages: Affected by use of antihistamines, false positives are noted, potential risk of anaphylactic reactions, not ideal for those with extensive eczema, trained professional must administer.²

Total Serum IgE (RAST or ELISA) – Sample of blood is taken to measure IgE amounts.

Advantages: More comfortable than skin tests, no risk of anaphylaxis, unaffected by medication use.

Disadvantages: Tests results delayed, requires large volume of blood for multiple tests which may be harder for younger children, high cost, fewer allergens tested.

Atopic Patch Test (APT) – Skin exposure to allergen over long period of time (24 – 72 hours). Used to assess non-IgE food allergy responses.

Advantages: Assesses late onset of symptoms, can help to identify allergens for patients with Eosinophilic Esophagitis or Atopic Dermatitis.

Disadvantages: Highly variable in testing method, preparations and results.

Oral Food Challenge – Specific foods are introduced to patient and symptoms are assessed. Must be a double blind placebo controlled food challenge.

Advantages: The most accurate testing method for food allergies, criterion standard.

Disadvantages: Risk of anaphylactic reactions, significant amount of time and man power needed, cost, facility must have proper tools and equipment to perform this test.

At times, some physicians may perform more than one type of test to ensure the most accurate results.

Have you had experience with any of these tests? Which did you find to be most accurate for your little ones?

- Christine

1. Schneider Chafen, J et al. Diagnosing and Managing Common Food Allergies: A Systematic Review. JAMA 2010;303(18):1848-1856

2. Huang, Shih-Wen, Allergy Testing in Children; Which Test When?. Consultant for Pediatricians 2010;9(3);93-100

We’re always keeping our eyes peeled and our ears tuned for new news on eosinophilic esophagitis (also EoE or EE). This matters to us because many children with EoE  use Neocate products, as part of their special, healthy diet.


The Study

Dr. Charles DeBrosse and Dr. James Franciosi at the Cincinnati Children’s Hospital, where there is a Center for Eosinophilic Disorders, recently published a new research study about the long-term effects of EoE.  If you’re interested in reading the study here are links to the study abstract as well as a great summary.


The Results

The research team looked at over 100 patients with esophagitis; some had EoE, while others had chronic esophagitis, and compared them to patients who had no esophagitis. On average, this was about 15 years after the patients developed esophagitis. EoE research was in its early stages back then, and many patients went undiagnosed or were misdiagnosed. The participants answered questions about their symptoms and quality of life. The researchers then compared the results of each of the groups to see what differences really stood out.

Patients with EoE reported a lower quality of life and experienced more trouble swallowing and had food become stuck in their esophagus more often. Those patients with higher eosinophil counts in childhood had more trouble swallowing as adults. Also, patients with a diagnosed food allergy were more likely to have trouble swallowing and to have food become stuck in their esophagus.


The Bottom Line

As the researchers concluded, EoE “is associated with reduced quality of life and persistent symptoms 15 years after presentation.” They also noted that both increased eosinophil counts and the presence of food allergy in childhood increase the rate of trouble swallowing in young adulthood. It doesn’t sound very positive, but it’s what many of us expected: there is a strong link between food allergies and symptoms among patients with EoE, and high eosinophil levels can have a lasting impact.


What Can We Take Away from This?

Sure, the results and conclusion don’t sound great at first, but there are a few things to keep in mind. For one, a HUGE amount of research has been conducted on EoE in the last 15 years, and we’ve learned a lot! Patients who had EoE 15 years ago had a much different experience than patients with EoE today have. For instance, the way that EoE is diagnosed and treated has improved in that time. Also, many more of today’s health care teams can recognize, diagnose, and treat EoE, which is more widely known. And many teams also include allergy testing as part of the care process for EoE.

There are also options for managing EoE that are now in wide use. For instance, elimination diets and elemental diets (which we’ll blog about in a few weeks – stay tuned) have come a long way. Elemental diets (or amino acid-based formulas) can be especially helpful in getting EoE under control and are useful in diagnostic phases. These formulas can help improve trouble swallowing when EoE isn’t under control, which can mean better outcomes. They can also provide key nutrients when added to a very limited diet.

Children on elemental diets have lots of options these days in the Neocate family of products. We have Neocate Junior, which is available in several flavors. We also have E028 Splash, which not only comes in multiple flavors, but is also in drink box form, so it’s just as ready-to-go as your child! And for children who miss solid textures on an elemental diet, Neocate Nutra can provide a change of scenery, especially prepared in one of our recipes.


What did you learn from the new research that was published in June?

- Rob 


[Photo: Microsoft Images]

You probably remember, like I do, dreading trips to the doctor as a kid. It seemed like nothing good came from those visits, except maybe a lollipop if I was well-behaved. Unfortunately, children who depend on Neocate have conditions like cow milk allergy and eosinophilic esophagitis(EoE), which can mean more doctor visits than usual. Those visits can involve some unpleasant tests. Here are some steps you can take to make those trips less scary for your little one.
 

Be Prepared

If nothing else, it can help you focus more on your little one and less on paperwork. Check out our previous blog that lists things you can do ahead of time to make the visit easier, especially when seeing a new doctor. The less stress you feel, the less stress your child will feel. Also, try to schedule the visit around meals and naps, when your little one won’t be tired or hungry.
 

Help Your Child to Prepare

It may seem silly, but simple things, like showing your little one what to expect, can make a big difference. First tell them, in simple terms, what the visit will involve. You may be able to read them a book (like this one about EoE) or watch a video about going to the doctor. It could even help to drop by the office ahead of time (to pick up paperwork) with your child, so he or she can become familiar with the office. Your child might enjoy role-playing a visit too – a toy doctor kit like this one can help them be more comfortable around medical instruments.
 

At the Office

On the day of your visit, ask your child which favorite toy, stuffed animal, or doll he or she wants to take along to provide comfort. Choices help children feel like they have some control. The doctor can examine the doll first, then your little one. This is a great way to show your child what to expect.

Many of us learn to associate the white lab coat with doctors at a young age. Seeing the coat can make us anxious. Many pediatricians do not wear one for this and other reasons, but if your child’s doctor does, you can ask them to remove it before coming in the room.

During the visit, remain calm and relaxed, since your child watches you to see how to behave. Give reassuring words and gentle contact during the exam. A distraction can also help, especially with shots. If you’re able to take a video game or a movie (on your phone), this can take your child’s focus off of the shot itself.
 

After the Visit

If possible, try to plan an activity that your little one enjoys after the visit. That way, going to the doctor becomes associated with something fun that is an activity to look forward to. After the visit is also a great time to break out the toy medical kit again, as this allows your child to think about the visit during play time.

What tips can you share with other parents to help make doctor visits less scary?

- Rob
 

[Photo: Microsoft Images]