TY - JOUR
T1 - Allergy-Test-Based Elimination Diets for the Treatment of Eosinophilic Esophagitis
T2 - A Systematic Review of Their Efficacy
AU - Pitsios, Constantinos
AU - Vassilopoulou, Emilia
AU - Pantavou, Katerina
AU - Terreehorst, Ingrid
AU - Nowak-Wegzryn, Anna
AU - Cianferoni, Antonella
AU - Tsigkrelis, Georgios Panagiotis
AU - Papachristodoulou, Maria
AU - Bonovas, Stefanos
AU - Nikolopoulos, Georgios K.
N1 - Publisher Copyright: © 2022 by the authors.
PY - 2022/10/1
Y1 - 2022/10/1
N2 - Eosinophilic esophagitis (EoE) is an immune-mediated esophageal disorder, linked with sensitization to food and airborne allergens. Dietary manipulations are proposed for the management of EoE inflammation and are often successful, confirming the etiological role of food allergens. Three different dietary approaches are widely used: the elemental, the empirical, and the allergy-test-driven approach. We performed a systematic review to assess the evidence on the association of allergens, detected by allergy tests, with clinically confirmed triggers of EoE. We systematically searched PubMed, Scopus, Embase, and the Cochrane Library, through 1 June 2021. We sought studies examining the correlation of skin-prick tests (SPT), atopy patch tests (APT), specific IgE, and serum-specific IgG4, with confirmed triggers of EoE. Data on the use of prick–prick tests were also extracted. Evidence was independently screened by two authors against predefined eligibility criteria. Risk of bias was assessed with the ROBINS-I tool. Of 52 potentially eligible studies, 16 studies fulfilling quality criteria were included. These studies used one to three different allergy tests detecting food sensitization. The positive predictive value was generally low to moderate but higher when a combination of tests was used than single-test evaluations. None of the selected studies used serum-specific IgG4. Although an extreme methodological variability was noticed in the studies, allergy-based elimination diets were estimated to be efficient in 66.7% of the cases. The efficacy of targeted elimination diets, guided by SPT, sIgE, and/or APT allergy tests, does not appear superior to empirical ones. In the future, tests using esophageal prick testing or ex vivo food antigen stimulation may prove more efficient to guide elimination diets.
AB - Eosinophilic esophagitis (EoE) is an immune-mediated esophageal disorder, linked with sensitization to food and airborne allergens. Dietary manipulations are proposed for the management of EoE inflammation and are often successful, confirming the etiological role of food allergens. Three different dietary approaches are widely used: the elemental, the empirical, and the allergy-test-driven approach. We performed a systematic review to assess the evidence on the association of allergens, detected by allergy tests, with clinically confirmed triggers of EoE. We systematically searched PubMed, Scopus, Embase, and the Cochrane Library, through 1 June 2021. We sought studies examining the correlation of skin-prick tests (SPT), atopy patch tests (APT), specific IgE, and serum-specific IgG4, with confirmed triggers of EoE. Data on the use of prick–prick tests were also extracted. Evidence was independently screened by two authors against predefined eligibility criteria. Risk of bias was assessed with the ROBINS-I tool. Of 52 potentially eligible studies, 16 studies fulfilling quality criteria were included. These studies used one to three different allergy tests detecting food sensitization. The positive predictive value was generally low to moderate but higher when a combination of tests was used than single-test evaluations. None of the selected studies used serum-specific IgG4. Although an extreme methodological variability was noticed in the studies, allergy-based elimination diets were estimated to be efficient in 66.7% of the cases. The efficacy of targeted elimination diets, guided by SPT, sIgE, and/or APT allergy tests, does not appear superior to empirical ones. In the future, tests using esophageal prick testing or ex vivo food antigen stimulation may prove more efficient to guide elimination diets.
KW - allergens
KW - allergy skin tests
KW - atopy patch tests
KW - elimination diet
KW - eosinophilic esophagitis
KW - prick to prick test
KW - skin prick tests
KW - specific IgE
KW - specific IgG4
UR - http://www.scopus.com/inward/record.url?scp=85139798595&partnerID=8YFLogxK
U2 - https://doi.org/10.3390/jcm11195631
DO - https://doi.org/10.3390/jcm11195631
M3 - Review article
C2 - 36233499
SN - 2077-0383
VL - 11
JO - Journal of clinical medicine
JF - Journal of clinical medicine
IS - 19
M1 - 5631
ER -