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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}

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]