Elimination Diet
Question: How do we know that the elimination diet is working for my child with an allergic eosinophilic gastrointestinal disorder?
Answer: If the patient affected by the allergic eosinophilic gastrointestinal disorder is having symptoms with certain foods and the symptoms disappear after elimination of those foods, that is an indication that the elimination diet is probably working. In practice this is difficult to figure out because (a) some patients have delayed reactions (up to several days later after ingestion) to foods and elimination of these foods for a few days might not be enough time; and (b) it is sometimes difficult to pinpoint exactly which foods are the culprit. The only way to figure this out is to do extensive allergy testing for foods. Some patients might eliminate only some of the foods that they are allergic to and in these cases the elimination diet is seen as a failure (because they did not eliminate all the foods that they are allergic to!). Several studies and our clinical experience have shown that patients improve on elemental diets. An elemental diet is a special diet that contains amino-acids (the building blocks of proteins, that are not recognized as allergens). In some very specific cases, such as allergic colitis of the infant (milk-induced eosinophilic colitis) elimination of milk from the diet is all that is needed. For eosinophilic esophagitis and gastroenteritis more extensive evaluation and treatments might be needed.
The only way, for sure, to know that the diet is working, is by performing a follow-up esophagogastroendoscopy with biopsies. The biopsies should show improvement. A good indicator of tissue improvement is the clinical improvement. That means, if the patient is doing better, the biopsies should be better.
