6 Foods to Avoid with Eosinophilic Esophagitis

Manage Flareups with Food

Eosinophilic Esophagitis (EoE) is a chronic immune system disease that affects the esophagus, causing inflammation and a range of uncomfortable symptoms. While the exact cause of EoE is still being studied, it is clear that diet plays a significant role in managing it. Certain foods can trigger flare-ups and worsen symptoms, making it crucial for individuals with EoE to identify and avoid these triggers. This article provides foods that patients with EoE should avoid, along with insights into the causes and treatment options, like DUPIXENT, an FDA-approved treatment that helps manage eosinophilic esophagitis (EoE) in people aged 12 years.

Foods to Avoid with EoE

1. Wheat

Wheat and wheat products, including bread, pasta and baked goods, are known to be common triggers for EoE. This is often due to an allergic reaction to proteins found in wheat. Opt for substitutes like quinoa, rice, rye and tapioca instead.

2. Milk

Dairy products, especially cow's milk, contain proteins like casein and whey that can provoke EoE symptoms. Avoiding milk, cheese, yogurt and other dairy items is advisable. Dairy-like products that are made from coconut milk are an excellent substitute for traditional milk-based foods.

3. Eggs

Eggs are a potential trigger due to the protein content in the egg whites. Patients with EoE are often advised to eliminate eggs from their diet. Many foods can replace the need for an egg including applesauce, mashed bananas, flaxseeds and arrowroot powder.

4. Nuts

Tree nuts and peanuts are allergenic and may exacerbate EoE symptoms. This includes almonds, walnuts, cashews and peanut products. Try using pumpkin, sesame and sunflower seeds as a substitute for nuts. Macadamia and pine nuts have also been known to be tolerated in many EoE cases.

5. Soy

Soy-based foods, such as tofu, soy milk and soy sauce, contain proteins that can contribute to EoE symptoms. It's important to read labels carefully as soy can be found in unexpected products. A great non-soy replacement option are coconut aminos, which is a rich, dark brown sauce produced through the fermentation of coconut palm sap coupled with sea salt. It bears a resemblance to soy sauce in taste but offers a subtle undertone of sweetness.

6. Fish and Shellfish

Seafood, particularly fish and shellfish, can be problematic for individuals with EoE. Allergenic proteins in these foods may trigger inflammation in the esophagus. Instead, opt for other animal proteins like poultry, beef and pork.

Other Potential Triggers

While the foods mentioned above are among the most common triggers for EoE, it's essential to recognize that individual reactions can vary. Some individuals may have additional trigger foods that are specific to their sensitivities. Keeping a detailed food journal can help identify patterns between consumed foods and symptom flare-ups.

Causes of Eosinophilic Esophagitis

The exact causes of EoE are still being investigated, but it's understood to be related to both genetic and environmental factors. Allergic reactions, especially to certain proteins in foods, are believed to play a significant role. EoE is characterized by an accumulation of white blood cells called eosinophils in the esophagus, which is triggered by an immune response to ingested allergens. This immune response leads to chronic inflammation and the range of symptoms experienced by EoE patients.

Treatment Options

Managing EoE involves a combination of dietary changes, medications and, sometimes, medical procedures. Here are some common treatment approaches.

  • Elimination diet: Working with a healthcare provider, patients can identify trigger foods through an elimination diet. This involves removing potential trigger foods from the diet for a period of time and then gradually reintroducing them one at a time to observe any reactions.
  • Proton pump inhibitors (PPIs): PPIs are medications that reduce stomach acid production, which can help alleviate symptoms and promote healing of the esophagus. They are often prescribed alongside dietary changes.
  • Corticosteroids: Topical corticosteroids, often in the form of swallowed aerosolized medications, can help reduce inflammation in the esophagus.
  • Biologic medications: In some cases, biologic medications that target specific immune system pathways may be prescribed to manage EoE symptoms.
  • Dilation: For individuals with narrowed esophagus due to chronic inflammation, esophageal dilation can be performed to widen the passage and alleviate swallowing difficulties.
  • DUPIXENT: Dupixent (dupilumab) is a medication used for the treatment of certain inflammatory conditions, particularly moderate-to-severe eczema (atopic dermatitis), asthma and eosinophilic esophagitis. It is a biologic drug that works by inhibiting specific pathways involved in the inflammatory response.

Final Notes

Eosinophilic Esophagitis can significantly impact an individual's quality of life, but with proper management, many patients can find relief from their symptoms. Identifying individual trigger foods and working closely with healthcare providers to develop a tailored treatment plan can greatly improve the lives of individuals with EoE.

Ongoing research is shedding light on the causes of EoE and leading to more effective treatment options, offering hope for better outcomes in the future.

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