Eosinophilic esophagitis (EoE) is a chronic immune and allergic condition in which eating certain foods can trigger inflammation and damage in the esophagus. If you or your child has EoE, it’s important to work with the right doctor who can recommend a treatment plan and help you find your food triggers.

An elimination diet will help you identify the food allergens that may cause symptoms such as impaction, reflux, and chronic cough. By identifying and temporarily removing common allergens from your diet, you can pinpoint the culprits and start feeling better. Keep reading to learn more about EoE and how an elimination diet can help.

EoE Elimination Diets

Avoiding specific food groups is a fundamental aspect of treating EoE, but it can take a little time and effort to identify which foods you need to cut. You’ll work with your allergist, gastroenterology specialist, or dietitian to remove certain foods from your diet. After a period of avoiding these foods, you’ll add them back in one at a time, paying close attention to your symptoms. This process should help determine which foods are safe and which should remain off-limits.

In an elimination diet, you avoid certain foods for a few weeks, then reintroduce them one at a time and watch for symptoms.

There are several types of elimination diets designed for managing EoE, typically categorized by the number of foods eliminated, such as six-food, four-food, and two-food elimination diets. Your doctor will recommend the one they believe is most suitable for you or your child, and your dietitian will give dietary therapy to ensure you’re getting all the nutrients you need.

6-Food Elimination Diet

The six-food elimination diet is the most common type of elimination diet for EoE. Research has shown that it helps about 70 percent of people with EoE by removing six common food triggers: dairy (cow’s milk), eggs, wheat, soy, fish, and nuts. This can significantly reduce the signs and symptoms of EoE.

The six-food elimination diet involves removing all of those food groups from the diet for six to eight weeks, then reintroducing one or two foods at a time to see how your body responds. Your doctor may perform endoscopies, in which they take a biopsy, or obtain tissue samples from your esophagus, to determine whether the reintroduced foods are causing damage.

If removing six foods at the same time feels too challenging at first, or if you are already on a restrictive dietary plan such as a vegan or ketogenic diet, you may want to consider doing an EoE elimination diet that removes fewer foods.

4-Food Elimination Diet

The four-food elimination diet removes four common trigger foods: dairy, soy, wheat, and eggs. This diet usually lasts for eight to 12 weeks and follows the same protocols as the six-food elimination diet, including endoscopy checkups.

2-Food Elimination Diet

The two-food elimination diet excludes only dairy and wheat for eight to 12 weeks. It is often the starting point for adults and children who are trying an elimination diet for the first time.

EoE Diet: 6 Foods To Avoid in an Elimination Diet

Since the six-food elimination diet is the most common, we’ll review all the food groups included in that plan. If you suspect a specific food may be the culprit behind your condition or symptoms, you should share that suspicion with your doctor or dietitian. They will tell you if focusing on that one food group is a good place to start.

The six-food elimination diet is often recommended for EoE. With it, you avoid dairy, eggs, wheat, soy, fish, and nuts.

1. Dairy Products

Dairy is one of the most common triggers for EoE symptoms. In fact, when it comes to the development of EoE, it’s the primary cause of symptom recurrence in children. The proteins in cow’s milk, casein and whey, can provoke an allergic reaction in sensitive people, leading to inflammation of the esophagus. Some people may also have reactions to other types of animal milk.

Dairy products include:

• Milk
• Cheese
• Yogurt
• Butter
• Ice cream

Casein and whey are also common in products such as protein powders and cheese-flavored snacks.

One good way to avoid dairy products is to switch to plant-based milk such as almond, oat, or coconut milk and vegan versions of yogurt or ice cream. However, this also depends on which elimination diet you or your child is trying.

2. Wheat

Wheat and wheat flours contain gluten, a protein that can trigger EoE symptoms for some people. It’s a common cause of EoE, which is why it’s one of the first food groups to be removed in an EoE elimination diet.

You can find wheat flours in bread, pasta, cereals, couscous, and many processed foods. It includes products made from common wheat, as well as spelt, durum, and semolina. Many packaged foods also include wheat flours, so it’s important to read food labels. If gluten is the issue, it’s also important to avoid foods that say they contain trace amounts of gluten. You should always choose oats that are specifically labeled as gluten-free, since oats often have cross-contamination with wheat. Thankfully, there are many wheat-free goods available these days, like gluten-free bread.

3. Eggs

Eggs are a well-known allergen that can trigger EoE symptoms. The proteins in eggs, particularly in the whites, can cause inflammation in the esophagus.

This means avoiding chicken eggs, as well as products that contain eggs, including mayonnaise, many baked goods, and some sauces. If you’re doing your own baking, you may be able to swap banana or applesauce for eggs. You can also use flaxseed as an egg substitute.

4. Soy

Soy is another common allergen that is often included in EoE elimination diets. Soy proteins can be inflammatory, leading to esophageal discomfort and other symptoms.

Soybeans and soy products include:

• Tofu
• Soy milk
• Edamame
• Soy sauce

Many processed foods, such as protein bars, soups, cookies, breakfast cereals, and processed meats, contain soy or soy derivatives, so it’s vital to check the label. Soy lecithin and processed soy oil may not cause a reaction in most people with EoE, but check with your allergist before trying it.

5. Nuts and Peanuts

Nuts are a common allergen and can be a significant trigger for EoE symptoms. Both tree nuts and peanuts contain proteins that can cause severe allergic reactions in sensitive individuals.

Dairy and wheat are the food groups most often recommended to avoid during an elimination diet.

Tree nuts include almonds, walnuts, and cashews. Peanuts are technically legumes, but they are often grouped with nuts. Avoid peanut butter and other nut butters. Seeds are a good substitute for nuts. You could also try seed-based butters, such as sunflower seed butter.

6. Fish and Shellfish

Seafood and shellfish are potent allergens. They are frequently associated with EoE triggers, which is why they are included in the six-food elimination diet. The proteins in these foods can lead to an allergic response, causing esophageal inflammation.

This category encompasses fish like salmon, tuna, and cod, as well as shellfish such as:

• Shrimp
• Crab
• Lobster
• Oysters

To swap seafood out of recipes, try replacing it with lean poultry or mushrooms.

Talk With Others Who Understand

On myEoEcenter, a meeting place for people with EoE or food allergies and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand.

Have you tried an elimination diet before? Did it help you learn which foods cause your symptoms? Share your experience in the comments below.