Eosinophilic esophagitis (EoE) is an allergic condition that causes inflammation in a person’s esophagus, which is the food pipe. People with EoE may need to avoid certain foods that trigger symptoms. They may do this by following an elimination diet.

EoE causes an immune cell buildup on the walls of the tube connecting the mouth to the stomach, which doctors call the esophagus. Healthcare professionals call these immune cells eosinophils, which respond to some foods by causing inflammation in the esophagus.

While elimination diets may help manage EoE symptoms, EoE is a lifelong condition. This article explores EoE and diet in more detail, including common trigger foods, types of elimination diets, and how to identify trigger foods. It also discusses other treatments for EoE and when to speak with a healthcare professional.

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Some foods can trigger reactions in people with EoE, but these reactions work differently from other food allergies. EoE causes a delayed reaction to foods over several days. This may make it difficult to determine which food is the trigger. More than one food may also be responsible for an immune reaction in those with EoE.

Healthcare professionals, such as allergists and dietitians, may help a person with EoE work out and exclude their trigger foods.

The foods that most commonly trigger EoE reactions include:

According to a 2018 study, the most common trigger is cow’s milk, then gluten and egg. Soy, legumes, and seafood are triggers for some people, although this is rarer.

However, it is important to note that triggers may vary between each individual with EoE.

Adjusting the diet is a common treatment for people with EoE. A healthcare professional may recommend certain diets, including the elemental diet and empirical food elimination diet (FED).


This diet excludes some known trigger foods. The first FED, or 6-FED, involved excluding all six most common trigger foods from the previous section above.

However, some doctors may recommend a less restrictive version, such as 4-FED. This only restricts four common trigger foods.

Elemental diet

This option involves cutting out all foods and instead consuming a formula containing amino acids, which are the building blocks of protein.

Research suggests that it is highly effective for both adults and children with EoE.

A person may find it challenging to restrict all six most common EoE trigger foods. For this reason, a healthcare professional may help someone work out which foods trigger their EoE flares so that they can find a sustainable method for avoiding them.

One approach is the “top-down” method, which involves cutting out the six trigger foods and reintroducing each one at a time. After each reintroduction, the doctor recommends an endoscopy to check the effects of the food on a person’s esophagus.

Another is the “step up” approach, which involves cutting out one or two of the more common triggers, including milk and wheat. If this does not resolve symptoms completely, the doctor may try a 4-FED or 6-FED approach.

A 2023 randomized trial followed 129 people on either a 6-FED or a 1-FED program that excluded only animal milk. The study concluded that cutting out animal milk led to similar remission rates as a 6-FED program. Therefore, removing milk alone from the diet could be an effective management strategy for EoE.

A person may find keeping a food diary helpful. They may record what they eat each day and whether they experience any EoE symptoms. A healthcare professional may also find a person’s food diary useful for identifying trigger foods.

Some medications can help reduce certain symptoms of EoE. However, people with EoE may need several treatments or balance dietary approaches with different medications. This may vary between each person depending on their age and other factors.

Acid suppressors, including proton pump inhibitors, can help reduce inflammation and acid reflux.

Steroids may also help reduce inflammation in the esophagus. People may take them through an inhaler or drink them as a liquid. However, a doctor may prescribe steroids in pill form for those whose symptoms are not well controlled with other medications or those experiencing significant weight loss.

A person needs to speak with a healthcare professional before making any significant dietary changes relating to suspected allergic reactions. A doctor will first need to diagnose EoE and rule out other conditions that may be causing any symptoms. They will then recommend appropriate treatment if necessary.

Additionally, people who experience regular or severe symptoms of EoE should consult with a physician. This includes individuals who require over-the-counter heartburn medication more than twice each week.

EoE is a chronic inflammatory disorder that affects a person’s esophagus. People with EoE may benefit from managing their diet to control their exposure to trigger foods.

There are different types of elimination diets for EoE, which involve removing common trigger foods from a person’s diet. Some of these foods include dairy products, gluten, and eggs. A healthcare professional can help someone work out which foods trigger their EoE symptoms.

Some individuals may need to take either steroids or acid-reducing medications to manage other symptoms. A person can speak with a doctor about which EoE treatments may benefit them.