6-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 all 6 foods from your 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:

  1. Introduce ONE new food per week. (Dairy, wheat, soy, eggs, nuts, or seafood/shellfish)
  2. Add 1 serving of the food in the morning. (Example: glass of milk or 1 slice of bread)
  3. If you don’t notice any symptoms, eat 2 larger portions in the afternoon and evening.
  4. Over the next 3 days, continue to eat at least 1 serving of the food per day.
  5. If the food does not cause symptoms, it is considered safe.
  6. Wait to add the safe food back into your diet until the other food challenges are complete.

Dairy Elimination

Food to avoid What to eat Brand Examples
  • Milk (cow, goat, and sheep)
  • Buttermilk
  • Condensed milk
  • Cream/artificial cream
  • Evaporated milk
  • Butter, butter oil
  • Ghee
  • Margarine
  • Cheese
  • Ice Cream
  • Yogurt
  • Sour Cream
  • Some mayonnaise and some salad creams

Ingredients that contain dairy:

  • Casein (curds), Hydrolyzed casein
  • Caseinates, calcium or sodium caseinate
  • Lactoglobulin
  • Lactoalbumin
  • Lactose
  • Milk powder
  • Milk protein
  • Milk sugar
  • Milk solids, Non-fat milk solids
  • Modified milk
  • Whey, Whey solids, Hydrolyzed whey, Hydrolyzed whey protein, Whey protein
  • Coconut, hemp, oat, almond, or rice milk
  • Dairy-free yogurts
  • Dairy-free cheeses
  • Coconut or cashew ice cream
  • Hemp products
  • Coconut milk products
  • Milk: Pacific Foods, So Delicious, Rice Dream, Blue Diamond
  • Yogurt: Coconut Dream, Good KARMA, So Delicious yogurts
  • Cheese: Daiya
  • Frozen Dessert: Haagen-Dazs Non-Dairy, So Delicious, Coconut Bliss, Ben & Jerry’s Non-Dairy
  • Butter: Earth Balance, Smart Balance

Wheat Elimination

Food to avoid What to eat Brand Examples
  • Bran
  • Bulger
  • Couscous
  • Durum
  • Einkorn
  • Emmer
  • Farina
  • Farro
  • Flour (wheat – all purpose, cake, enriched, graham, pastry)
  • Gluten
  • Hydrolyzed wheat protein
  • Kamut
  • Semolina
  • Spelt
  • Wheat (berries, bran, grass, malt, starch)

Ingredients may contain wheat:

  • Artificial/natural flavoring
  • Caramel color
  • Dextrin
  • Food starch*, gelatinized starch,
  • Glucose syrup
  • Hydrolyzed or textured vegetable protein
  • Maltodextrin
  • Monosodium glutamate
  • Oats
  • Soy sauce, shoyu, teriyaki
  • Beer
  • Bouillon cubes
  • Brown rice syrup
  • Candy, Licorice
  • Deli meats, hot dogs, sausage, imitation fish
  • Communion wafers
  • French Fries
  • Gravy, sauces, soups
  • Seitan
  • Gluten-free foods

Wheat substitutes:

  • Amaranth
  • Arrowroot
  • Barley
  • Beans / legumes
  • Buckwheat
  • Corn
  • Oats (gluten-free)
  • Potato
  • Quinoa
  • Rice
  • Rye
  • Tapioca

 

  • Grains: Bob’s Red Mill
  • Breads: Canyon Bakehouse, Udi’s, Food for Life, New Cascadia Traditional
  • Cereals: Nature’s Path, Arrowhead Mills, GF Chex
  • Crackers: Blue Diamond Nut Thins (contain dairy), Mary’s Gone Crackers, Glutino
  • Pasta: GF Barilla, POW
  • Wraps: Rudi’s, Mission

Egg Elimination

Food to avoid What to eat Brand Examples
  • Eggs (yolks, whites, dried, powdered, and solids)
  • Egg substitites (e.g. EggBeaters)
  • Eggnog
  • Egg noodles
  • Egg sauces (hollandaise, bernaise)
  • Baked goods (bagels, some breads, cookies, cakes, donuts, muffins, pancakes, waffles)
  • Batters
  • Caesar dressing
  • Cream fillings
  • Custard-type desserts
  • Crepes
  • French toast
  • Frostings (some)
  • Ice cream (some)
  • Malted milk mixes (Ovaltine)
  • Mayonnaise
  • Meatloaf, meatballs, sausages, bologna
  • Meringue
  • Mousse
  • Pastas (fresh)
  • Puddings
  • Soups (noodle/consume, egg drop, wonton)
  • Tartar sauce

Ingredients may contain egg:

  • Albumin
  • Binder
  • Coagulant
  • Gobulin
  • Lecithin (unless soy) 
  • Egg-free foods
  • Egg substitutes (1 egg):
  • ¼ cup applesauce
  • ¼ cup mashed banana
  • 1 Tbsp ground flax + 3 Tbsp water
  • 1 tsp baking soda + 1 Tbsp vinegar
  • 2 Tbsp arrowroot powder + 3 Tbsp water 

 

  • EnerG egg replacer
  • OrgraN
  • Bob’s Red Mill Gluten Free Vegan Egg Replacer 

Soy Elimination

Food to avoid What to eat Brand Examples
  • Foods to avoid What to eat Brand Examples
  • Edamame
  • Miso
  • Natto
  • Shoyu
  • Soy (soy cheese, soy flour, soy ice-cream, soy milk, soy nuts, soy yogurts)
  • Soy sauce, tamari
  • Soya
  • Tempeh
  • Textured Vegetable Protein (TVP)
  • Tofu, bean curd

 

  • Soy sauce substitute, Coconut Aminos
  • Soy lecithin is OK
  • Refined soybean oil is OK
  • Coconut Secret Coconut Aminos (soy sauce substitute)

Peanuts and Tree Nut Elimination

Food to avoid What to eat Brand Examples
  • All tree nuts (walnut, almond, hazelnut, cashew, pistachio, Brazil nut)
  • Nut butters
  • Natural nut extract
  • Nut meal, past, meat, pieces
  • Cold pressed, expeller or extruded peanut or tree nut oils
  • Macadamia and pine nuts are usually tolerated
  • Coconut and coconut products
  • Pumpkin, sesame and sunflower seeds
  • Sunflower seed spread
  • Heat-pressed peanut oil is OK 

Peanut butter alternatives:

  • SunButter
  • Once Again Organic Sunflower Seed Butter
  • 88 Acres
  • Don’t Go Nuts Spread

Bars:

  • Enjoy Life
  • go Raw
  • Made Good
  • 88 Acres 

Fish and Shellfish Elimination

Food to avoid What to eat Brand Examples
  • All fish
  • All crustacea (shrimp, crab, lobster)
  • All mollusks (oysters, clams, mussels, scallops)
  • Remember that finned fish and shellfish are not related. Being allergic to one does not mean that you must avoid both.
  • Macadamia and pine nuts are usually tolerated
  • Coconut and coconut products
  • Pumpkin, sesame and sunflower seeds
  • Sunflower seed spread
  • Heat-pressed peanut oil is OK 

Peanut butter alternatives:

  • SunButter
  • Once Again Organic Sunflower Seed Butter
  • 88 Acres
  • Don’t Go Nuts Spread

Bars:

  • Enjoy Life
  • go Raw
  • Made Good
  • 88 Acres 

Reading a Food Label

Dairy Example: There are three ways milk may be indicated on a label. See examples below:
 
1. Within ingredient list in parenthesis ( )
  • INGREDIENTS: CASEIN (MILK), DIPOTASSIUM PHOSPHATE, NATURAL FLAVOR
2. Within ingredient list in BOLD.
  • INGREDIENTS: MILK CASEIN, DIPOTASSIUM PHOSPHATE, NATURAL FLAVOR
3. As a separate statement after the ingredient list. See example below:
  • INGREDIENTS: CASEIN, DIPOTASSIUM PHOSPHATE, NATURAL FLAVOR CONTAINS: MILK

 

Sample Menu: Wheat and Dairy Free

  Day 1 Day 2 Day 3 Day 4

Breakfast

Breakfast sausage or ham, 1 banana or apple, 2 Tbsp sunflower seed butter  Smoothie: unsweetened milk alternative, banana, berries, greens, protein powder 

GF Oatmeal (prepared with milk alternative) blueberries, hemp seeds

Coffee (w/coconut creamer) 

Allergen free waffle with 100% pure maple syrup, berries

Milk alternative 

Lunch Green salad with chicken, black beans, salsa, and avocado  Tuna salad lettuce wraps, side of walnuts or olives and grapes 

Rice with beans, grilled vegetables, GF corn chips, lettuce, salsa, cheese substitute 

GF wrap with chicken, vegan mayonnaise, avocado slices 

Dinner Pot roast with potatoes, carrots, and green beans, olive oil  BBQ chicken, sweet potato, and slaw 

Grilled pork chop, GF pasta with vegetables

Baked apple with cinnamon 

Beef tenderloin, rice, olive oil, steamed broccoli

Orange 

Snack Fruit or rice crackers with nut butter  Veggie sticks with hummus 

Allergen free pretzels and hummus

Coconut milk ice cream 

Seed mixture with allergen free chocolate
Mini rice cakes with sunflower seed butter

 

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/