Introduction: The six food elimination diet (SFED) is the main nonpharmacologic treatment strategy in eosinophilic esophagitis (EoE), but ishampered by the need for multiple EGDs. Skin prick testing (SPT) directed elimination is ineffective, butis limited by measurement of an IgE rather than Th2 mediated response. Allergy patch testing (APT), by virtue of prolonged skin exposure to allergens, measures a delayed hypersensitivity reaction more akin to EoE. While pediatric studies have suggested greater success with APT than SPT, adult studies using APT in EoE are lacking. Methods: Adult EoE patients completed the MDQ-30 questionnaire prior to enrollment. APT with antigens applied using Finn chambers were interpreted at 48 and 72 hours in a clinical Dermatology lab. The presence of erythema or papules constituted a positive result. Food antigens included beef, turkey, tomato paste, applesauce, potato flour, corn flour, barley flour, rice flour, rye flour, garbanzo bean flour, soy protein powder, wheat flour, almond flour, egg white powder, dry milk powder, fish flakes, and peanut butter. Thereafter, a SFED of milk, wheat, eggs, soy, nuts, and fish was followed for6 weeks.Dietitian visitsat initiation and completion as well as phone interviews at 2 and 4 weeks were conducted. Patientsnonresponsive to the SFED completed an extended SFED which included corn and legumes. Patients with symptomatic and histologic remission ( < 15 eos per HPF) underwent systematic food reintroduction with EGD and biopsies to identify culprit food antigens. Results: A total of 7 patients were recruited, with 4 of the 7 responsive to SFED with an additional patient responsive to an extended SFED. Of the 5 patients responsive to dietary therapy, 2/5 (40%) had a single food trigger, with the other three patients having 4 food triggers (60%). Among the 5 responders, APT had poor predictive value, with a sensitivity of 7.1% (0.4%, 35.8%) and specificity of 100% (77.8%, 100%). The specificity of the test was limited by the fact that APT was rarely positive. In fact 4 of 5 SFED responders and 5 patients overall demonstrated no reaction to any antigen on APT. Further, even in the two patients with reactions, one patient reacted to only wheat and egg while the other reacted only to nuts.Table 1Conclusion: APT demonstrated poor predictive value for causative food antigens in EoE. Specifically, this test demonstrated poor sensitivity, with positive results seen rarely. APT does not appear useful in a directed elimination diet for EoE.