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:

Introduce ONE new food per week. (Dairy, wheat, soy, eggs, nuts, or seafood/shellfish)
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 food does not cause symptoms, it is considered safe.
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.	Other animal-based proteins, including poultry, beef, bison, pork, venison, and other animal-based proteins that don’t include fish, shellfish, dairy, or eggs.	N/A

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