Abstract
We appreciate the interest of Paquet et al1Paquet B. Begin P. Paradis L. Drouin E. Des Roches A. Variable yield of allergy patch testing in children with eosinophilic esophagitis.J Allergy Clin Immunol. 2013; 131: 613Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar in our letter2Molina-Infante J. Martin-Noguerol E. Alvarado-Arenas M. Porcel-Carreño S.L. Jimenez-Timon S. Hernandez-Arbeiza F.J. Selective elimination diet based on skin testing has suboptimal efficacy for adult eosinophilic esophagitis.J Allergy Clin Immunol. 2012; 130: 1200-1202Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar and feel encouraged to see how our results can be replicated by other groups. The authors show that, in their experience, the low accuracy of atopy patch test (APTs) to detect offending foods in adults with eosinophilic esophagitis (EoE) might also be applied to children. Therefore, age may not be a sufficient explanation for the suboptimal yield of APTs in adults with EoE, as we hypothesized in our study.2Molina-Infante J. Martin-Noguerol E. Alvarado-Arenas M. Porcel-Carreño S.L. Jimenez-Timon S. Hernandez-Arbeiza F.J. Selective elimination diet based on skin testing has suboptimal efficacy for adult eosinophilic esophagitis.J Allergy Clin Immunol. 2012; 130: 1200-1202Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar As research incessantly grows in EoE, the concept of a shared etiopathogenesis between children and adults is gaining attention.3Straumann A. Aceves S.S. Blanchard C. Collins M.H. Furuta G.T. Hirano I. et al.Pediatric and adult eosinophilic esophagitis: similarities and differences.Allergy. 2012; 67: 477-490Crossref PubMed Scopus (179) Google Scholar The main difference reported so far between them is that EoE in children seemed to be primarily driven by a food antigen, whereas in adults it was common to detect aeroallergen sensitization. However, 2 recent studies4Gonsalves N. Yang G.Y. Doerfler B. Ritz S. Ditto A.M. Hirano I. Elimination diet effectively treats eosinophilic esophagitis in adults: food reintroduction identifies causative factors.Gastroenterology. 2012; 142: 1451-1459Abstract Full Text Full Text PDF PubMed Scopus (457) Google Scholar, 5Lucendo A.J. Arias A. Gonzalez-Cervera J. Gonzalez-Castillo S. Rodriguez-Dominguez B. Guagnozzi D. et al.Efficacy of sixfood elimination diet in adult eosinophilic oesophagitis: a prospective study.Gut. 2011; 60: A42Google Scholar have documented similar efficacy of 6-food elimination diet in adults with EoE (70%), comparable to that previously reported in children. Overall, these reports, including the letter by Paquet et al,1Paquet B. Begin P. Paradis L. Drouin E. Des Roches A. Variable yield of allergy patch testing in children with eosinophilic esophagitis.J Allergy Clin Immunol. 2013; 131: 613Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar certainly come to add new similarities between EoE in children and adults. It is well known that current diagnostic methods for food allergy have limited accuracy and their results in EoE are notably discrepant. The reason for this is not well understood, and diagnostic tests for non–IgE-mediated food allergy, such as APT, remain to be refined and validated. In agreement with Paquet et al, as we already remarked for both children6Henderson C.J. Abonia J.P. King E.C. Putnam P.E. Collins M.H. Franciosi J.P. et al.Comparative dietary therapy effectiveness in remission of pediatric eosinophilic esophagitis.J Allergy Clin Immunol. 2012; 29: 1570-1578Abstract Full Text Full Text PDF Scopus (212) Google Scholar and adults4Gonsalves N. Yang G.Y. Doerfler B. Ritz S. Ditto A.M. Hirano I. Elimination diet effectively treats eosinophilic esophagitis in adults: food reintroduction identifies causative factors.Gastroenterology. 2012; 142: 1451-1459Abstract Full Text Full Text PDF PubMed Scopus (457) Google Scholar, 5Lucendo A.J. Arias A. Gonzalez-Cervera J. Gonzalez-Castillo S. Rodriguez-Dominguez B. Guagnozzi D. et al.Efficacy of sixfood elimination diet in adult eosinophilic oesophagitis: a prospective study.Gut. 2011; 60: A42Google Scholar in the last sentence of our letter,2Molina-Infante J. Martin-Noguerol E. Alvarado-Arenas M. Porcel-Carreño S.L. Jimenez-Timon S. Hernandez-Arbeiza F.J. Selective elimination diet based on skin testing has suboptimal efficacy for adult eosinophilic esophagitis.J Allergy Clin Immunol. 2012; 130: 1200-1202Abstract Full Text Full Text PDF PubMed Scopus (95) Google Scholar “six-food elimination diet seems the better dietary approach for EoE until more accurate food testing or genetic profiling predicting the response to diet are available.” Variable yield of allergy patch testing in children with eosinophilic esophagitisJournal of Allergy and Clinical ImmunologyVol. 131Issue 2PreviewMolina-Infante et al1 published a prospective study in which they performed selective elimination diets in a cohort of 22 adults with eosinophilic esophagitis (EoE). They reported poor performance of skin prick and allergy patch tests (APTs) at identifying relevant foods. Another striking observation was their low rate of positive patch test results to foods (only 5 patients [23%] having a positive result), which contrasts with the very high rate reported in a previous large pediatric cohort, reaching up to 85%. Full-Text PDF
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