Efficacy of a 4-Food Elimination Diet for Children With Eosinophilic Esophagitis  Amir F. Kagalwalla, Joshua B. Wechsler, Katie Amsden, Sally Schwartz, Melanie Makhija, Anthony Olive, Carla M. Davis, Maria Manuel- Rubio, Seth Marcus, Ronda Shaykin, Maureen Sulkowski, Kristen Johnson, Jessica N. Ross, Mary Ellen Riffle, Marion Groetch, Hector Melin-Aldana, Deborah Schady, Hannah Palac, Kwan-Youn A. Kim, Barry K. Wershil, Margaret H. Collins, Mirna Chehade  Clinical Gastroenterology and Hepatology  Volume 15, Issue 11, Pages 1698-1707.e7 (November 2017) DOI: 10.1016/j.cgh.2017.05.048 Copyright © 2017 AGA Institute Terms and Conditions

Figure 1 Diagram outlining the order of food reintroduction in responders. Single foods reintroduced every 8 weeks in 4-FED responders starting with soy, egg, wheat, and milk. Inflammation-inducing trigger foods removed followed by a normal baseline EGD demonstrating remission of inflammation before the next food reintroduction. 4-FED, 4-food elimination diet. Clinical Gastroenterology and Hepatology 2017 15, 1698-1707.e7DOI: (10.1016/j.cgh.2017.05.048) Copyright © 2017 AGA Institute Terms and Conditions

Figure 2 Diagram of patient flow. Ninety-six patients were screened for the study; 18 were excluded and 78 underwent upper endoscopy with biopsies after 4-FED. Fifty demonstrated histologic remission. 4-FED, 4-food elimination diet. Clinical Gastroenterology and Hepatology 2017 15, 1698-1707.e7DOI: (10.1016/j.cgh.2017.05.048) Copyright © 2017 AGA Institute Terms and Conditions

Figure 3 Food triggers identified in subjects reintroducing between 1 and 4 foods in the diet and in those who reintroduced all foods back. (A) Food triggers in patients who reintroduced 1–4 foods. (B) Food triggers in 25 patients who completed reintroduction of all foods. This included 3 subjects with anaphylaxis to egg (2) and soy (1) who did not reintroduce these foods in their diet. (C) Distribution by number of food triggers in 25 who reintroduced all foods. Clinical Gastroenterology and Hepatology 2017 15, 1698-1707.e7DOI: (10.1016/j.cgh.2017.05.048) Copyright © 2017 AGA Institute Terms and Conditions

Figure 4 Comparison of histology with symptom response, endoscopic findings, and weight z scores. (A) Eosinophil counts at 6 different time points: baseline; post-4-FED; and after introduction of soy, wheat, egg, and milk. (B) Symptom scores at 6 different time points: baseline; post-4-FED; and after introduction of soy, wheat, egg, and milk. (C) Endoscopic scores at 6 different time points: baseline; post-4-FED; and after soy, wheat, egg, and milk. (D) Weight z scores at 6 different time points: baseline; post-4-FED; and after soy, wheat, egg, and milk. 4-FED, 4-food elimination diet; EREFS, Edema Rings Exudate Furrowing Stricture. Clinical Gastroenterology and Hepatology 2017 15, 1698-1707.e7DOI: (10.1016/j.cgh.2017.05.048) Copyright © 2017 AGA Institute Terms and Conditions

Supplementary Figure 1 ROC curve identifying factors associated with response with an area under the curve of 0.8. ROC curve for final multivariable model identified asthma, family history of food allergy, and positive serum sIgE test to any of the 4 foods as significantly associated with treatment nonresponse. The area under the curve of the final model was 0.8. ROC curve, receiver operating characteristic curve. Clinical Gastroenterology and Hepatology 2017 15, 1698-1707.e7DOI: (10.1016/j.cgh.2017.05.048) Copyright © 2017 AGA Institute Terms and Conditions