2-Food Elimination for Eosinophilic Esophagitis (EOE)
Research shows a strong connection between food allergies and eosinophilic esophagitis (EOE). These six foods are most commonly associated with this allergic response: dairy, wheat, soy, eggs, nuts, and seafood/shellfish.
Unfortunately, there is no accurate test to identify food allergies connected with EOE. Elimination diets help to identify food allergies and improve your condition. Start by eliminating two of the most common food allergies; dairy and wheat.
How to do an elimination diet:
Step 1. Plan
Work with your healthcare team to identify which foods might be causing symptoms. Plan a time to start the diet when you know you can be successful. Prepare yourself by having the foods you will need on hand and prep as much as possible in advance.
Step 2. Eliminate
Remove dairy and wheat products from the diet for 4 weeks without any exceptions. It is important to read food labels and use caution when dining out, since you have less control over the ingredients in restaurants.
Step 3. Challenge
If your symptoms have not improved after 4 weeks, follow up with your health care provider.
If your symptoms have improved, start the challenge phase with ONE of the foods you stopped eating at a time. As you do this, write down your symptoms.
Symptoms of a failed food challenge may range from mild reflux, or pains, to severe cramps, vomiting, or difficulty swallowing – even food impaction. Any of these changes after reintroducing a food should be written down and considered a reaction. It is common for EOE food reactions to be delayed for hours or even days from exposure.
Challenge Instructions:
- Introduce ONE new food per week. (Dairy or wheat)
- Add 1 serving of the food in the morning. (Example: glass of milk or 1 slice of bread)
- If you don’t notice any symptoms, eat 2 larger portions in the afternoon and evening.
- Over the next 3 days, continue to eat at least 1 serving of the food per day.
- If the challenged food does not cause symptoms, it is considered safe.
- Wait to add the safe food back into your diet until the other food challenge is complete.
Dairy Elimination
Food to avoid | What to eat | Brand Examples |
Ingredients that contain dairy:
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Wheat Elimination
Food to avoid | What to eat | Brand Examples |
Ingredients may contain wheat:
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Wheat substitutes:
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Reading a Food Label
- INGREDIENTS: CASEIN (MILK), DIPOTASSIUM PHOSPHATE, NATURAL FLAVOR
- INGREDIENTS: MILK CASEIN, DIPOTASSIUM PHOSPHATE, NATURAL FLAVOR
- INGREDIENTS: CASEIN, DIPOTASSIUM PHOSPHATE, NATURAL FLAVOR CONTAINS: MILK
Sample Menu: Wheat and Dairy Free
Day 1 | Day 2 | |
Breakfast |
Breakfast sausage or ham, 1 banana or apple, 2 Tbsp sunflower seed butter | Smoothie: unsweetened milk alternative, banana, berries, greens, protein powder |
Lunch | Green salad with chicken, black beans, salsa, and avocado | Tuna salad lettuce wraps, side of walnuts or olives and grapes |
Dinner | Pot roast with potatoes, carrots, and green beans, olive oil | BBQ chicken, sweet potato, and slaw |
Snack | Fruit or rice crackers with nut butter | Veggie sticks with hummus |
Resources
American Academy of Allergy Asthma & Immunology: https://www.aaaai.org/conditions-and-treatments/related-conditions/eosinophilic-esophagitis
American Partnership for Eosinophilic Disorders: https://apfed.org/resources/for-healthcare-providers-and-researchers/patient-handouts/
American College of Gastroenterology: http://patients.gi.org/topics/eosinophilic-esophagitis/