PMID- 31294369
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220409
IS  - 2515-2092 (Electronic)
IS  - 2515-2084 (Print)
IS  - 2515-2084 (Linking)
VI  - 2
IP  - 2
DP  - 2019 May
TI  - Liberalized Versus Strict Cow's Milk Elimination for the Treatment of Children 
      with Eosinophilic Esophagitis.
PG  - 81-85
LID - 10.1093/jcag/gwy030 [doi]
AB  - OBJECTIVES: Cow's milk is a commonly implicated trigger in eosinophilic 
      esophagitis (EoE). Exclusive cow's milk avoidance has been reported previously, 
      but the degree of elimination required for remission is unclear. Strict food 
      avoidance may confer a risk of developing immunoglobulin E (IgE)-mediated 
      allergy. The goal of this study was to evaluate the effectiveness of cow's milk 
      elimination (CME) in children with EoE and compare responses of strict and 
      liberalized CME diets. METHODS: Children (</=16 years) diagnosed with EoE who were 
      treated with exclusive CME diets were evaluated clinically and histologically. 
      Strict diets eliminated all milk products, including 'may-contain' and baked milk 
      goods. Liberalized diets eliminated obvious sources including milk, cheese, 
      yogurt, cream-based products but permitted foods with traces of milk and baked 
      goods. RESULTS: Cow's milk elimination induced histological remission of <15 
      eosinophils per high-powered field in 18 of 31 children (58%) and complete 
      remission in 23%. Overall, 77% had decreased eosinophils with this single 
      intervention. Symptoms were improved in 90% of patients, regardless of histologic 
      response. A liberalized (n=7) CME diet was associated with a nonsignificantly 
      lower response compared with strict (n=24) elimination (29% versus 67%, P=0.099). 
      Eight responders to strict elimination were transitioned to a liberalized diet; 
      63% maintained remission. CONCLUSION: Cow's milk elimination induced 
      clinicopathological remission in a majority of patients with EoE, supporting its 
      use as a first-line intervention. Liberalized CME allows dietary freedom and may 
      prevent subsequent development of anaphylactic milk allergy but may be inferior 
      to strict CME for improving EoE.
FAU - Teoh, Timothy
AU  - Teoh T
AUID- ORCID: 0000-0003-4707-1968
AD  - University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, 
      Canada.
FAU - Mill, Christopher
AU  - Mill C
AD  - BC Children's Hospital, Division of Allergy and Immunology, Department of 
      Pediatrics, Vancouver, British Columbia, Canada.
FAU - Chan, Edmond
AU  - Chan E
AD  - University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, 
      Canada.
AD  - BC Children's Hospital, Division of Allergy and Immunology, Department of 
      Pediatrics, Vancouver, British Columbia, Canada.
FAU - Zimmer, Preeti
AU  - Zimmer P
AD  - BC Children's Hospital, Division of Gastroenterology, Hepatology and Nutrition, 
      Department of Pediatrics, Vancouver, British Columbia, Canada.
FAU - Avinashi, Vishal
AU  - Avinashi V
AD  - University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, 
      Canada.
AD  - BC Children's Hospital, Division of Gastroenterology, Hepatology and Nutrition, 
      Department of Pediatrics, Vancouver, British Columbia, Canada.
LA  - eng
PT  - Journal Article
DEP - 20180704
PL  - England
TA  - J Can Assoc Gastroenterol
JT  - Journal of the Canadian Association of Gastroenterology
JID - 101738684
PMC - PMC6507290
OTO - NOTNLM
OT  - Eosinophilic esophagitis
OT  - Food allergy
OT  - Food elimination diet
EDAT- 2019/07/12 06:00
MHDA- 2019/07/12 06:01
PMCR- 2018/07/04
CRDT- 2019/07/12 06:00
PHST- 2019/07/12 06:00 [entrez]
PHST- 2019/07/12 06:00 [pubmed]
PHST- 2019/07/12 06:01 [medline]
PHST- 2018/07/04 00:00 [pmc-release]
AID - gwy030 [pii]
AID - 10.1093/jcag/gwy030 [doi]
PST - ppublish
SO  - J Can Assoc Gastroenterol. 2019 May;2(2):81-85. doi: 10.1093/jcag/gwy030. Epub 
      2018 Jul 4.