Eosinophilic esophagitis is a chronic, immune-mediated esophageal disease triggered predominantly, but not exclusively, by food antigens. Presently, available food allergy tests are suboptimal to predict food triggers for eosinophilic esophagitis, especially in adults. Elemental diets (exclusive feeding with amino acid–based formulas) and empiric 6-food elimination diets (withdrawing milk, wheat, egg, soy, nuts, and fish/seafood for 6 weeks) have consistently shown the best efficacy rates. However, their high level of restriction and need for multiple endoscopies have hampered their implementation in clinical practice. Currently, milk, wheat/gluten, and egg are the most common food triggers in children and adults from the United States, Spain, and Australia. Hence less restrictive empiric schemes, such as a 4-food elimination diet (dairy, gluten-containing cereals, egg, and legumes) or a 2-food elimination diet (dairy and gluten-containing cereals) have been lately developed with good efficacy rates (2-food elimination diet, 43%; 4-food elimination diet in adults, 54%; and 4-food elimination diet in children, 64%). A step-up approach (2-4-6) might result in prompt recognition of a majority of responders with few food triggers, reducing the number of endoscopies and costs and shortening the diagnostic process. Standardization of food reintroduction, novel food allergy testing, and studies evaluating a milk elimination diet in children and the long-term outcomes of dietary interventions are warranted.

嗜酸性食管炎是一种慢性的，免疫介导的食道疾病，主要但并非唯一地由食物抗原触发。目前，可用的食物过敏测试对于预测嗜酸性粒细胞性食管炎的诱因是次佳的，特别是在成年人中。元素饮食（不包括基于氨基酸的配方食品）和经验丰富的6种食物消除饮食（6周内不摄取牛奶，小麦，鸡蛋，大豆，坚果和鱼类/海鲜）一直显示出最佳的疗效。然而，它们的高水平限制和对多种内窥镜检查的需求阻碍了它们在临床实践中的实施。当前，牛奶，小麦/面筋和鸡蛋是来自美国，西班牙和澳大利亚的儿童和成人中最常见的食物诱因。因此，限制较少的经验方案，例如消除4种食物的饮食（乳制品，最近开发出了含麸质的谷物，鸡蛋和豆类食品或消除两种食物的饮食（乳制品和含麸质的谷物），具有较高的功效率（消除两种食物的饮食占43％；消除了成年人的四种食物的饮食） ，54％；以及4种消除儿童饮食的饮食（64％）。逐步采取的方法（2-4-6）可能会导致迅速识别大多数反应者而很少触发食物，从而减少了内窥镜检查的次数和成本，并缩短了诊断过程。重新引入食物的标准化，新颖的食物过敏测试以及评估儿童排乳饮食和饮食干预措施的长期结果的研究是必要的。成年人中消除4种食物的饮食占54％；和4种消除儿童饮食的饮食，占64％）。逐步采用方法（2-4-6）可能会导致对大多数反应者的识别迅速而很少触发食物，从而减少内窥镜检查的次数和成本，并缩短诊断过程。重新引入食物的标准化，新颖的食物过敏测试以及评估儿童排乳饮食和饮食干预措施的长期结果的研究是必要的。成年人中消除4种食物的饮食占54％；和4种消除儿童饮食的饮食，占64％）。逐步采取的方法（2-4-6）可能会导致迅速识别大多数反应者而很少触发食物，从而减少了内窥镜检查的次数和成本，并缩短了诊断过程。重新引入食物的标准化，新颖的食物过敏测试以及评估儿童排乳饮食和饮食干预措施的长期结果的研究是必要的。