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Cow's Milk Elimination: A Novel Dietary Approach to Treat Eosinophilic Esophagitis

Kagalwalla, Amir F.*; Amsden, Katie*; Shah, Ameesh*; Ritz, Sally*; Manuel-Rubio, Maria*; Dunne, Katherine*; Nelson, Suzanne P.; Wershil, Barry K.*; Melin-Aldana, Hector

Journal of Pediatric Gastroenterology & Nutrition: December 2012 - Volume 55 - Issue 6 - p 711–716
doi: 10.1097/MPG.0b013e318268da40
Original Articles: Gastroenterology

Objectives: Cow's-milk protein is one of the food antigens responsible for causing eosinophilic esophageal inflammation in a majority of children. We describe our experience with treating eosinophilic esophagitis (EoE) in children by eliminating only cow's milk from their diets.

Methods: This retrospective study assessed the short-term clinical and histological response to eliminating cow's-milk protein from the diet of children with EoE. Only patients undergoing a subsequent upper endoscopy to assess their histological response were included in this analysis.

Results: We identified 17 (12 boys and 5 girls) children with EoE who excluded only cow's milk from their diet. Remission was induced in 11 of 17 (65%) patients; within the remission group, 7 (41%) achieved complete histological remission and 4 patients (24%) were in significant histological remission. The mean peak pre- and posttreatment counts for those in remission were 76 ± 40 and 2 ± 4 (P < 0.01), respectively.

Conclusions: Elimination of cow's milk–induced clinical and histological remission in 65% (95% confidence interval 42%–88%) of children with EoE in whom it was attempted. This approach offers distinct advantages over other dietary treatment approaches for the initial management of children with EoE. The role of eliminating cow's milk alone for the treatment of EoE warrants further prospective study.

*Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago

Children's Gastroenterology Specialists, S.C., Glenview

Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL.

Address correspondence and reprint requests to Amir F. Kagalwalla, MD, Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 65, Chicago, IL 60611 (e-mail: akagalwalla@luriechildrens.org).

Received 6 February, 2012

Accepted 23 May, 2012

This project was financially supported in part by the Buckeye Foundation.

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN