The elemental or hypoallergenic formula diet is the strictest and most effective form of dietary therapy. An elemental formula (such as Neocate, Elecare, or Puramino) is made from amino-acids which are the basic building blocks for proteins. It is completely free of any milk or soy proteins. As such these formulas are very well tolerated and should not cause an allergic reaction. They are 100% nutritionally complete so no other source of nutrition is needed while on an elemental diet.

The decision to be placed on an elemental diet needs to be discussed between you and your physician. In general, treatment failures are very rare with elemental diets. Several studies evaluating elemental diets in children with eosinophilic esophagitis have shown complete resolution of disease in 95% cases or more. It may be difficult for some children to drink enough formula to maintain adequate nutrition. In these cases, a G tube or nasogastrostomy (NG) tubes may be needed to provide sufficient nutrition for a child.

Unacceptable forms of nutrition in an elemental diet include hydrolyzed formulas where milk or soy protein are hydrolyzed or broken down into smaller peptides but still retain some degree of allergenic potential.