Use of Food Allergy Testing Beyond the Six Common Food Allergies in Eosinophilic Esophagitis

Food allergy testing related to eosinophilic esophagitis (EoE) in the pediatric population relies on percutaneous testing to a small group of foods thought to cause EoE. Using specific IgE testing is not well-studied in this population. Here we present a child with EoE and food allergies, determined by both percutaneous and specific IgE allergy tests. IgE testing performed by ViraCor-IBT and percutaneous testing with Quintip. We present a 3 year old male with Opitz G syndrome and EoE diagnosed in 2013 by biopsy, which showed >15 eosinophils/hpf in the mid and distal esophagus. He empirically began the six-food elimination diet (SFED), which prohibits milk, egg, soy, wheat, nuts, and seafood. A year later, after continued emesis and choking with pureed foods, repeat biopsies revealed >20 eosinophils/hpf on lansoprazole therapy. After reports of angioedema with accidental exposure to egg and peanuts, IgE testing was performed, which was positive to almond, banana, egg, milk, peanut, soy, and walnut. Despite avoiding these foods, emesis after feeds persisted. He was skin-tested for foods outside of the standard testing done for EoE, but were common in his diet. His skin test was positive for pineapple, garlic, peas, coconut, and chicken. He was recommended to strictly avoid all of these foods due to IgE-mediated allergic reactions based on skin and blood testing. This case emphasizes the importance of expanding percutaneous and IgE testing to foods that are common in the patient’s diet, in addition to the six common foods known to cause EoE.