Identification of Specific Foods Responsible for Inflammation in Children With Eosinophilic Esophagitis Successfully Treated With Empiric Elimination Diet
Identification of Specific Foods Responsible for Inflammation in Children With Eosinophilic Esophagitis Successfully Treated With Empiric Elimination Diet
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DOI：
10.1097/mpg.0b013e31821cf503
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发表时间：
2011-08-01
影响因子：
2.9
通讯作者：
Nelson, Suzanne P.
中科院分区：
文献类型：
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作者：
Kagalwalla, Amir F.;Shah, Ameesh;Nelson, Suzanne P.
目的：嗜酸性食管炎（EoE）是一种由食物抗原引发的免疫介导的慢性炎症性疾病。6种食物消除饮食（SFED）不包括牛奶、大豆、小麦、鸡蛋、花生/树坚果和海鲜，已被证明可以缓解大多数EoE儿童。本研究的目的是确定特定的食物抗原负责嗜酸性粒细胞食管炎症的儿童EoE已达到组织学缓解的SFED。患者和方法：在本分析中，我们回顾性分析了EoE患儿，他们完成了随后的单一食物重新引入，从而确定了导致疾病复发的食物。在单一食物引入后进行重复上颌内窥镜活检。食道嗜酸性粒细胞增多症在食物重新引入后复发，确定了食物抗原是EoE的一个原因。结果：共有36/46 （25 M/11F）名最初成功接受SFED治疗的儿童完成了这项试验；平均年龄7.6±4.3岁。最常见的食物是25对牛奶（74%），8对小麦（26%），4对鸡蛋（17%），3对大豆（10%）和1对花生（6%）。牛奶引起EoE的可能性是小麦的8倍，小麦是第二常见的食物（95%置信区间2.41-26.62,P = 0.0007）。结论：用SFED诱导组织学缓解后，连续的单一食物重新引入可以在EoE中识别特定的致病食物抗原。牛奶是接受SFED治疗的EoE患者中最常见的食物。一部分患有EoE的儿童在使用SFED时可能会对他们的食物敏感性产生耐受性。
Objectives: Eosinophilic esophagitis (EoE) is an immune-mediated chronic inflammatory disorder triggered by food antigen(s). A 6-food elimination diet (SFED) excluding cow's milk, soy, wheat, egg, peanuts/tree nuts, and seafood has been shown to induce remission in a majority of children with EoE. The goal of the present study was to identify specific food antigens responsible for eosinophilic esophageal inflammation in children with EoE who had achieved histological remission with the SFED.Patients and Methods: In this analysis, we retrospectively analyzed children with EoE who completed subsequent single-food reintroductions that led to identification of foods causing disease recurrence. Repeat upper endoscopy with biopsies was performed after single-food introductions. Recurrence of esophageal eosinophilia following a food reintroduction identified that food antigen as a cause of EoE.Results: A total of 36/46 (25 M/11F) children who were initially successfully treated with SFED completed this trial; the mean age was 7.6 +/- 4.3 years. The most common foods identified were 25 to cow's milk (74%), 8 to wheat (26%), 4 to eggs (17%), 3 to soy (10%), and 1 to peanut (6%). Milk was 8 times more likely to cause EoE compared with wheat, the next most common food (95% confidence interval 2.41-26.62, P = 0.0007).Conclusions: Serial single-food reintroductions following induction of histological remission with the SFED can lead to the identification of specific causal food antigen(s) in EoE. Cow's milk was the most common food identified in subjects with EoE treated with SFED. A subset of children with EoE may develop tolerance to their food sensitivities while on the SFED.