A common variation of this diet involves removing the six most common foods that have been seen in allergic diseases, that is milk, egg, wheat, soy, peanuts/tree nuts, and seafood (fish/shellfish).  This is really 8 foods – but who’s counting?

This diet was initially proposed by a gastroenterologist due to limited access to allergists to perform a food allergy evaluation for eosinophilic esophagitis. Removal of these foods resulted in an 88% resolution of disease in children with eosinophilic esophagitis (Six Food Elimination Diet Trial). The response rate is good, however, this diet can be quite challenging to follow. Major changes are required in daily eating and living habits and supplementation with a amino-acid based formula is often required.

When embarking on this diet, counseling with a dietitian is strongly recommended to ensure adequate nutrition is maintained. Similar to specific food elimination diets, feeling very comfortable with reading ingredient labels is absolutely necessary.

If you imagine the typical American diet – most foods will contain at least one of these ingredients.  So it can feel overwhelming to find foods that are allergy-friendly, nutritious and taste good.  Not to mention the costs of these specialty foods can leave you with sticker shock and an emptiness in your wallet.

Because nuts and seafood have been recognized to be less common triggers of EoE, some have recommended a four food elimination diet avoiding milk, egg, wheat, and soy which still is clearly a challenging diet.