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Eosinophilic Esophagitis Improves With Dupilumab Regardless Of Food Elimination Diets
March 02, 2025
2 min read
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SAN DIEGO — Adolescents and adults with eosinophilic esophagitis improved with dupilumab regardless of whether they were practicing food elimination diets during treatment, according to a poster presented here.
The impact of concurrent food elimination diets on medication efficacy previously was unknown, Antonella Cianferoni, MD, PhD, associate professor of pediatrics, Perelman School of Medicine at the University of Pennsylvania, said at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress.
Data were derived from Cianferoni A, et al. Poster 453. Presented at: 2025 AAAAI/WAO Joint Congress; Feb. 23-March 3, 2025; San Diego.
"EoE is a chronic, progressive disease driven in part by type 2 inflammation that damages the esophagus and impairs its function," Cianferoni told Healio. "Food elimination diets are an established EoE treatment, but it is not known whether they impact the efficacy of medicines."
Patients may see improvements in their underlying inflammation with elimination diets, she continued, but these diets can be burdensome to sustain in the long term.
"That said, this trial did not measure the efficacy of elimination diets in EoE, but rather the efficacy of dupilumab with or without the use of these diets," Cianferoni said.
Among the 89 adolescents and adults who were on a food elimination diet for EoE at screening, 61.3% (95% CI, 42.2%-78.2%) of those on weekly 300 mg doses of dupilumab (Dupixent; Sanofi, Regeneron) and 3.4% (95% CI, 0.1%-17.8%) of those on placebo had a total of 6 or fewer eosinophils per high power field at week 24.
Percentages of patients who did not have a food elimination diet during treatment with 6 or fewer eosinophils per high power field at week 24 included 57.1% (95% CI, 42.2%-71.2%) of the treatment group and 8% (95% CI, 2.2-19.2) of the placebo group, which the researchers called comparable with those who maintained food elimination diets.
Absolute mean changes in Dysphagia Symptom Questionnaire scores at week 24 included –26.25 with treatment and –18.27 with placebo, both with a concurrent food elimination diet, and –21.43 with treatment and –10.39 with placebo, both with no food elimination diet, which the researchers also called comparable.
The diet and non-diet groups had similar improvements in Endoscopic Reference Scores and EoE Histologic Scoring System results at week 24 as well, the researchers continued.
Further, improvements in these endpoints persisted among the patients using dupilumab through 52 weeks of treatment regardless of whether they were on a food elimination diet. Patients who switched from placebo to dupilumab at week 24 saw similar improvements through 52 weeks, the researchers added.
"Endoscopic and histological measurements showed a significant difference (P < .0001) between dupilumab and placebo groups regardless of food elimination diet," Cianferoni said. "In this post-hoc analysis, P values were derived by analysis of covariance model stratified by age group and use of proton pump inhibitors at randomization."
Based on these findings, the researchers concluded that patients experienced histologic, symptomatic and endoscopic improvements in EoE with dupilumab regardless of their diets. In other words, Cianferoni said, patients who use dupilumab do not have to adjust their diets.
"At 6 months, dupilumab increased the proportion of patients who achieved histological disease remission, improved swallowing and reduced abnormal endoscopic findings and disease severity and extent at the microscopic level compared to placebo in patients irrespective of their food elimination diet," Cianferoni said. "These improvements were sustained up to 1 year."
Although the trial is complete, Cianferoni said, the researchers will continue to analyze the data for further insights.
"Additionally, a phase 4 study is ongoing to determine the long-term efficacy of dupilumab and its impact on esophageal remodeling in EoE," Cianferoni said.
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Beyond The Bite: EoE And Food Allergy
Eosinophilic esophagitis (EoE) is a non-IgE-mediated food allergy that happens when large numbers of eosinophils, a type of allergy-related white blood cell, gather in the esophagus (the tube that connects the mouth to the stomach). As a result, the lining of the esophagus becomes inflamed, making it difficult for food to go down. EoE is diagnosed by taking multiple biopsies from the esophagus and looking for eosinophils under a microscope.
About 1 in 700 people in the U.S. Have eosinophilic esophagitis (EoE).
There has been a continuous increase in EoE prevalence for the past 15 years. According to a 2025 study, the prevalence of EoE in the U.S. Is approximately 1 in 700, with an annual economic impact of $1.3 billion (in 2024 dollars)1.
Certain foods can trigger EoE, and symptoms vary depending on age. With infants and toddlers, families often note feeding difficulties, irritability and poor weight gain. Older children typically have regurgitation (spitting up), vomiting, heartburn and belly pain. Teenagers and adults may have chest pain, difficulty swallowing and a feeling that food "gets stuck" when they swallow.
The best way to determine which foods are contributing to EoE is to remove the food from the diet and repeat the biopsy to see if the eosinophils have gone away. Traditional allergy testing has not been shown to consistently indicate which foods are triggering symptoms.
Find additional EoE resources at the Cincinnati Children's Hospital Center for Eosinophilic Disorders site.
1Thel HL, Anderson C, Xue AZ, Jensen ET, Dellon ES. Prevalence and Costs of Eosinophilic Esophagitis in the United States. Clin Gastroenterol Hepatol. 2025 Feb;23(2):272-280.E8. Doi: 10.1016/j.Cgh.2024.09.031. Epub 2024 Oct 31. PMID: 39486752; PMCID: PMC11761390.
Interdisciplinary Care, Adherence Challenges Common In Eosinophilic Esophagitis Treatment
March 02, 2025
3 min read
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Key takeaways:SAN DIEGO — Treatment for eosinophilic esophagitis often involves collaboration between specialists, but patients face challenges in adherence, according to a pair of posters presented here.
Models for multidisciplinary care and identifying these barriers may improve outcomes, Hannah Jaffee, MS, director of research, Asthma and Allergy Foundation of America (AFAA), said at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress.
Data were derived from Jaffee H, et al. Poster 776. Presented at: 2025 AAAAI/WAO Joint Congress; Feb. 28-March 3, 2025; San Diego.
"Since it was first characterized in 1993, prevalence of EoE has steadily increased in the United States," Jaffee told Healio. "Research suggests EoE significantly impacts patients and their families physically, socially, mentally and financially."
Hannah Jaffee
But less has been known about the various factors that contribute to these impacts across the patient journey, from pre-diagnosis to long-term management, she continued.
With that, the AAFA and the American Partnership for Eosinophilic Disorders (APFED) collaborated on a survey to better understand the patient journey and current state of EoE care in the United States, Jaffee said.
"We also wanted to identify unmet needs for EoE patients, family members and clinicians to outline opportunities to improve EoE care in the United States," Jaffee said.
The 13-minute, self-reported survey polled 160 adults with EoE or caregivers of a patient with EoE (54% adult patients; 46% caregivers; 89% white; 85% female) in addition to 110 clinicians who treat EoE.
Clinicians included gastroenterologists (35%), primary care providers (24%), allergists and immunologists (19%), otolaryngologists (10%), nurses or physician assistants (6%), ED physicians (4%) and other (2%).
Approximately two-thirds of patients (65%) saw more than one type of health care provider for their EoE, including gastroenterologists (81%), allergists and immunologists (62%), primary care providers (38%), dietitians (15%) and psychologists (4%).
The health care providers reported high levels of collaboration between specialists. For example, all the allergists and immunologists said that they collaborate with gastroenterologists when they treat patients with EoE.
Also, 82% of gastroenterologists and 69% of primary care physicians said they collaborate with allergists and immunologists in EoE care, and 62% of gastroenterologists, 62% of allergists and immunologists and 69% of primary care physicians said they collaborate with dietitians and nutritionists.
"Multidisciplinary care in EoE can help reduce redundancies and improve patient care. Different specialists can help manage different aspects of EoE, and our study found that people with EoE often see more than one type of health care provider for their EoE care," Jaffee said.
"Having multidisciplinary care models can help establish protocols for different specialists to work together to provide coordinated patient-centered medical care," she continued.
As for treatment, 57% of patients and caregivers reported using elimination diets, 34% reported using proton pump inhibitors, 25% reported using swallowed glucocorticoids and 9% reported using biologics.
Treatments reported by clinicians included proton pump inhibitors, with 47% reporting that they always prescribe them, and elimination diets, with 18% reporting that they always prescribe them.
The most common challenge in EoE management was patient adherence to treatment, reported 76% of the clinicians. Adherence was better in pharmacological treatments, as 87% of clinicians said they saw more than 50% adherence, compared with diet therapy, with 40% of clinicians reporting more than 50% adherence.
Specifically, 43% of clinicians and 64% of patients and caregivers called diet management a significant challenge.
Based on these findings, the researchers called multidisciplinary care common in EoE treatment, with reduced redundancy and improved outcomes possible with established models for multidisciplinary care. Further, they said, identifying barriers to treatment adherence and developing strategies for overcoming them would improve outcomes as well.
"Our research showed that only 15% of EoE patients report seeing a dietitian or nutritionist who can provide tailored guidance on dietary therapy and nutrition. Additionally, among the clinicians we surveyed, less than 20% said they collaborate with psychologists for EoE care," Jaffee said.
"Given the intricacies of dietary treatment, and the psychosocial toll of EoE, incorporating these professionals into multidisciplinary care models can help further ensure efficient and comprehensive EoE care," she added.
Jaffee also noted that dietary restrictions can be burdensome for patients with EoE and their families, requiring planning and impacting dining out, holidays, social gatherings and travel, among other activities. Plus, specialty foods and formula can be cost barriers.
"Most EoE patients and caregivers surveyed in our study cited diet management as the biggest challenge with EoE management," Jaffee said. "The cost of food management, impacts on social life, and trigger management were all listed as challenges in open-ended responses as well."
The clinicians who responded reported better adherence to pharmacological treatments, she further explained, but proton pump inhibitors, topical corticosteroids and other treatments are not indicated specifically for EoE treatment, limiting access and insurance coverage.
"Additionally, insurance requirements may delay or prevent the use of biologics for EoE," she said.
Noting how respondents listed diet management as a major challenge, Jaffee said increased awareness of available resources to help implement and manage dietary therapy among health care providers is important.
"This can help providers expand practical strategy resources to help improve adherence," she said. "For better adherence to pharmacological treatments, clinicians can use shared decision-making tools that consider patients' lifestyles and preferences to determine an appropriate course of therapy that patients can reasonably access, afford and adhere to."
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