However, each patient can have a unique set of EoE triggers, which is why individualized care from a multidisciplinary team is so important.
EoE diet tips
Following an elimination diet can be difficult, but even patients and families who were once wary of dietary therapy have successfully adapted their lifestyles with education and support from our team. Learn some of our specialists’ tips for managing an EoE diet below.
Reading food labels
It’s easier to identify the foods that are off-limits when they stand alone. It’s harder to identify those foods when they’re included in prepackaged items like baked goods or salad dressing. That’s why following an elimination diet requires understanding the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA).
FALCPA requires labeling the top eight food allergens (milk, egg, wheat, soy, peanut, tree nuts, fish and crustacean shellfish) on all packaged foods sold in the United States.
Tips for reading food labels
Here are our top tips for reading food labels while following an EoE diet:
- Read the complete ingredient list: Food manufacturers list an allergen either in parentheses or bold.
- Watch for the “contains” statement: The producer may also list allergens in a separate statement after the ingredient list; for example, “Contains wheat and milk.”
- Use caution with advisory labeling: Advisory or precautionary labeling includes statements like “May contain,” “Manufactured on the same equipment as” or “Manufactured in the same facility as” following the ingredient list. Manufacturers include these labels on a voluntary basis. For kids with EoE, eating these prepackaged foods is generally OK, unless they have an IgE-mediated food allergy. Consult your dietitian for specific advice, and when in doubt, call the manufacturer.
- Know the difference between gluten-free and wheat-free: Gluten is found in wheat, rye and barley. If a product is labeled gluten-free, then it is also wheat-free. However, not all wheat-free products are also gluten-free because they may contain rye or barley. You can use the gluten-free label to narrow down your choices, but you should always read the label completely to ensure it’s safe.
- Know your shellfish: Mollusks, which include oysters, clams, mussels and scallops, are not considered major allergens under FALCPA. Mollusks will be in the ingredient list, but not identified in the contains statement. However, crustaceans (crab, lobster and shrimp) will be clearly identified.
- Look for flavors, colors and additives: All flavors, colors and food additives are subject to allergen labeling requirements. Any foods that contain a major food allergen (the top eight) will be identified.
- Disregard all claims on the front of the package: Food claims on the front of packages are not regulated by the FDA. Be careful with the foods that include claims like “dairy-free,” and always read the food label. When in doubt, call the manufacturer for clarification.
- Rest easy about imported products: Packaged foods that have been imported to the U.S. are subject to the same FALCPA food labeling rules.
- Check and re-check the label: Even if you have read a food label before, read it again the next time you purchase it as the ingredients or recipe may have changed.
For more information, check out FALCPA Questions and Answers.
Alternative ingredients for EoE elimination diets
Fortunately for kids with food allergies and sensitivities, today’s grocery and specialty stores offer myriad ingredients that can replace or add options to their overall diet. Though a registered dietitian at Children’s Colorado will recommend the best alternatives for your child’s specific allergens and nutritional needs, here are some tips and ideas for common alternative ingredients.
There are many alternatives to cow’s milk including almond, cashew, coconut, flaxseed, hemp, oat, pea and rice milks.
Tips for milk alternatives:
- Good protein sources include pea, oat and hemp milks. Coconut, almond, cashew and rice milks are not rich in protein.
- Many dairy alternative milks can be high in added sugar. Choose “original” or “unflavored” options to avoid excessive sugar.
Carbohydrates are the main fuel for the body, and wheat is the most common source of carbohydrates in most “kid friendly” foods like bread, pizza and pasta. If your child avoids wheat, other whole-grain alternatives include:
Tips for flour alternatives and baking:
- For baking needs, start with a general gluten-free all-purpose flour. This is because the company has taken the guesswork out of balancing the different properties of gluten-free flours.
- Choose a product with xanthan gum (or add your own) to avoid a crumbly result.
- If a recipe calls for milk, an equal measurement of most milk alternatives will work.
- If the recipe calls for eggs, there are many items already in your cupboard, like applesauce, that you can use instead.
EoE diet recipes and snacks
There are several online resources for recipes, snacks and meal planning ideas for families with EoE. Some include:
- Kids With Food Allergies is a website that includes a large collection of “free of” recipes submitted by parents of children with food allergies. Use the search box to browse by category or mark specific ingredients that the recipes shouldn’t include.
- Spoon Guru is a mobile app that allows you to build a unique dietary profile. Then, by scanning barcodes in the grocery store, the app can help you determine if the prepackaged product is safe for your child to eat.
- SnackSafely.com provides a safe snack guide for kids with food allergies and tools for school.
- EatLove is a paid meal planning service that can accommodate health and dietary needs, including elimination diets. Their paid plan provides recipes, grocery lists and the option for delivery.
Learn about even more EoE resources, like books and advocacy organizations.
How we can help with your child’s EoE elimination diet
We’re here to help your family navigate the world of eosinophilic conditions – from diagnosis to empiric elimination diets and beyond. As part of our consultation with every family facing EoE, our registered dietitians will share:
- How to read food labels and look for hidden ingredients
- Tips for navigating the grocery store
- How to avoid cross contamination at home, school and anywhere your child will encounter food
- Pointers on preparing for social activities that are centered around eating like holidays, birthday parties, school events and vacations
We help patients from across the U.S. and internationally. For more information and referrals, please call 720-777-7457.
Please note: The information presented is intended for educational purposes only. It is not intended to take the place of your personal doctor’s advice and is not intended to diagnose, treat, cure or prevent any disease. The information should not be used in place of a visit, call consultation or advice of your doctor or other healthcare provider.