期刊
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
卷 129, 期 6, 页码 1570-1578出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2012.03.023
关键词
Eosinophilic esophagitis; eosinophils; histologic remission; pediatric; dietary therapy; food allergy; negative predictive values; elemental diet; 6-food elimination diet; skin test-directed elimination diet
资金
- Campaign Urging Research for Eosinophilic Disease (CURED)
- Buckeye Foundation
- International Group of Eosinophilic Researchers (TIGER)
- Institutional Clinical and Translational Science Award
- National Institutes of Health (NIH)/National Center for Research Resources [5UL1RR026314]
- National Institutes of Health (NIH)
- Ception Therapeutics
- Children's Digestive Health and Nutrition Foundation
Background: Eosinophilic esophagitis is a chronic, immune-mediated inflammatory disorder that responds to dietary therapy; however, data evaluating the effectiveness of dietary therapeutic strategies are limited. Objective: This study compared the effectiveness of 3 frequently prescribed dietary therapies (elemental, 6-food elimination, and skin prick and atopy patch-directed elimination diets) and assessed the remission predictability of skin tests and their utility in directing dietary planning. Methods: A retrospective cohort of proton-pump inhibitor-unresponsive, non-glucocorticoid-treated patients with eosinophilic esophagitis who had 2 consecutive endoscopic biopsy specimens associated with dietary intervention was identified. Biopsy histology and remissions (<15 eosinophils/high-power field) after dietary therapy and food reintroductions were evaluated. Results: Ninety-eight of 513 patients met the eligibility criteria. Of these 98 patients, 50% (n = 49), 27% (n = 26), and 23% (n = 23) received elemental, 6-food elimination, and directed diets, respectively. Remission occurred in 96%, 81%, and 65% of patients on elemental, 6-food elimination, and directed diets, respectively. The odds of postdiet remission versus nonremission were 5.6-fold higher (P = .05) on elemental versus 6-food elimination diets and 12.5-fold higher (P = .003) on elemental versus directed diets and were not significantly different (P = .22) on 6-food elimination versus directed diets. After 116 single-food reintroductions, the negative predictive value of skin testing for remission was 40% to 67% (milk, 40%; egg, 56%; soy, 64%; and wheat, 67%). Conclusion: All 3 dietary therapies are effective; however, an elemental diet is superior at inducing histologic remission compared with 6-food elimination and skin test-directed diets. Notably, an empiric 6-food elimination diet is as effective as a skin test-directed diet. The negative predictive values of foods most commonly reintroduced in single-food challenges are not sufficient to support the development of dietary advancement plans solely based on skin test results. (J Allergy Clin Immunol 2012;129:1570-8.)
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据