The following is a summary of “Six-Food Elimination Diet Is Less Effective During Pollen Season in Adults With Eosinophilic Esophagitis Sensitized to Pollens,” published in the November 2023 issue of Gastroenterology by Visaggi, et al.
The influence of inhaled and ingested aeroallergens on the treatment outcomes of adult patients with eosinophilic esophagitis (EoE) remains uncertain. For a study, researchers hypothesized that the pollen season contributes to the ineffectiveness of the 6-food elimination diet (SFED) in EoE.
The study compared outcomes of EoE patients who underwent SFED during vs. outside of the pollen season. Consecutive adult patients with active EoE (≥15 eosinophils/high-power field) before SFED, undergoing both SFED and skin prick tests (SPT) for birch and grass pollen, were included. Analysis of individual pollen sensitization and pollen count data determined whether patients were assessed during or outside the pollen season post-SFED. All patients strictly adhered to the diet under dietitian supervision.
Of the 58 included patients, 62.0% had positive SPT for birch and/or grass, while 37.9% had negative SPT. Overall SFED response was 56.9% (95% CI, 44.1%–68.8%). Stratifying response based on assessment during or outside the pollen season revealed significantly lower SFED response in patients sensitized to pollens during the pollen season compared to outside (21.4% vs. 77.3%; P = 0.003). Furthermore, during the pollen season, patients with pollen sensitization exhibited significantly lower SFED responses than those without sensitization (21.4% vs. 77.8%; P = 0.01).
The study suggested that pollens may sustain esophageal eosinophilia in sensitized adults with EoE despite their avoiding trigger foods through SFED. Skin prick tests for pollens could potentially identify patients less likely to respond to the diet during pollen season.