Elimination diet effectively treats eosinophilic esophagitis in adults; food reintroduction identifies causative factors
Background & Summary: Eosionophilic esophagistis is a condition in which the lining of the esophagus becomes inflamed and narrowed. Dysphagia, food impaction and heartburn are common symptoms. A diet eliminating wheat, milk, soy, egg, peanuts/tree nuts and fish/shellfish was found to be an effective treatment in pediatric patients. This study investigated the benefits of an elimination diet with adult patients. Fifty adults with confirmed esosinophilic esophagitis (biopsy of esophageal lining showed increased inflammatory markers) followed the elimination diet for six weeks. Thirty-five patients showed complete remission (based on post diet biopsy), 7 patients had partially remission and 8 patients did not respond. Dysphagia symptoms also significantly improved. The patients with complete remission introduced one eliminated food every two weeks. If symptoms returned, a biopsy was completed to confirm relapse. The trigger food was removed from the diet and no new foods were introduced for 6 weeks. Another biopsy was done to ensure remission before new foods were introduced. Trigger foods were identified in all patients that completed the food challenge phase. The most common foods to provoke symptoms were milk and wheat. In all patients, symptoms were evident within 5 days. Skin testing was completed prior to the study, but the results did not correlate with the food triggers identified through food challenge. Additionally, patients with confirmed food triggers did not report symptoms associated with these foods prior to the study.
Application to Dietetic Practice: 1) Dietitians can suggest that patients with symptoms suggestive of eosinophilic esophagitis speak with their physicians. 2) Results from this study and others can be used to advocate for dietary therapy in this condition. 3) Milk and wheat appear to be the most common food triggers (from this and other studies).
Pub Med ID: 22391333
Background & Summary: DRACMA is a World Health Organization consensus document on the diagnosis and management of cow’s milk allergy (Reference).
This article discusses the implementation of DRACMA and how it would influence formula selection for a patient with cow’s milk allergy. A helpful chart indicates the first and second choice of formula for different types of cow’s milk allergy.
Application to Dietetic Practice: Dietitians can use this article to guide and support formula recommendations for individual patients and for the development of departmental standards.
Pub Med ID: 22544227
Timing the transfer of responsibilities for anaphylaxis recognition and use of an epinephrine auto-injector from adults to children and teenagers: pediatric allergists’ perspective
Background & Summary: Food anaphylaxis is usually diagnosed in young children. Adult caregivers are trained to recognize symptoms and carry/administer epinephrine auto-injector. As the child ages, this responsibility gradually shifts from the adult to child. This survey showed that pediatric allergists begin transferring responsibility to the child by 12 – 14 years of age. However, many factors influence readiness.
Application to Dietetic Practice:Dietitians are not primarily responsible for anaphylaxis education, but can reinforce the education given by the physician, nurse or pharmacist and report concerns to the physician. Assessment questions can include – does the client carry their auto-injector (did they bring it to the appointment); has it expired; does the client know how to use it (demonstrating with a trainer); does the client know when to use it. With young children, these questions would be directed to the parent. Gradually, these questions can shift to the child. If the child does not show any ability, knowledge or interest in their anaphylaxis management by 12 – 14 years of age, the dietitian should discuss the importance of this with the client and let the physician know.
Pub Med ID: 22541402
Background & Summary: Many egg allergic children tolerate extensively baked egg. Regularly eating baked egg appears to accelerate tolerance to raw egg. This paper summarizes a retrospective chart review of 100 egg allergic children that were referred to the Jaffe Food Allergy Institute at the Mount Sinai school of Medicine. Sixty-six percent (66%) of egg-allergic patients tolerated baked egg (in a muffin). The patients that tolerated baked egg, had a significantly lower serum egg white specific IgE than patients that reacted. Those that tolerated the baked egg were encouraged to include in their regular diet.
Application to Dietetic Practice: 1) Dietitians are being asked to provide guidance to families that need to include baked egg in the diet. This paper includes brief instruction given to families. 2) When counselling clients with egg allergy, the dietitian can encourage families to discuss the possibility of an oral food challenge with their allergist.
PubMed ID: 22657409
Description: Clients often come to dietitians with a long list of foods to avoid based on non-validated testing. It is difficult to approach these cases, especially if the testing has been completed by a physician. A good strategy is to review a handout with the client. The dietitian is not giving her opinion on the testing, but is communicating information that was written by an expert.
Target Audience: Public, but would also help professionals understand the basics of food allergy testing.
Organization: Written by David Stukus, MD & available through Kids with Food Allergies Website
Description: The Food Allergy & Anaphylaxis Network (FAAN) has joined with the Food Allergy Initiative (FAI) to create a new organization, Food Allergy and Research Education (FARE). Food Allergy & Anaphylaxis website is packed with helpful client and professional resources. Many of these resources will be available after the merger, and the website address (www.foodallergy.org) will remain the same. A new logo and website will be released in early 2013.
Target Audience: Client and professionals
Description: The Celiac Center in Boston has launched a comprehensive website for the nutritional management of celiac disease. Dietitians with long waiting lists may want to recommend this website to their celiac clients to help them get on the right track while they wait for their appointment.
Target Audience: Public
Organization: Celiac Disease Center: Beth Israel Deaconess Medical Center (Boston)