Food Allergy
Question: My child has no outward signs of a food allergy but has a high level of eosinophils present in his / her endoscopy biopsy as well as positive skin tests to several foods. Does this mean that he / she has food allergy and we should eliminate the foods he tested positive to?
Answer: The presence of eosinophils in gastrointestinal tissue biopsies does not necessarily mean food allergies. First, it depends upon the level of eosinophils -- the higher the more likely. But even if the child has very high levels, this does not mean that the positive foods in skin testing are the cause of the problem. Over 80 percent of individuals with eosinophilic esophagitis and eosinophilic gastroenteritis have positive skin tests to multiple foods. However, the benefit of a specific allergen elimination diet has not yet been proven. We are currently analyzing our own cohort of patients to answer this, but it is too early to tell. Our current approach however is to eliminate foods that children are positive to on skin tests.
After 3 months we re-endoscope the patients and if the biopsies are still not improved, we then start medical therapy -- especially with steroids -- either through an inhaler or directly swallowed. Finally, some patients benefit from a special "elemental diet" that consists only of amino acids (no proteins). While amino acid diets are hard to comply with, they can have very positive effects on eosinophil-associated gastrointestinal diseases.
