Eosinophilic esophagitis is a chronic allergic/immune condition of the esophagus, causing a large number of white blood cells (known as eosinophils) in the inner lining of the esophagus. These eosinophils can release substances into surrounding tissue, causing inflammation, eosinophilic asthma symptoms, and other symptoms such as decreased appetite, abdominal pain, trouble swallowing, vomiting, and so on. Symptoms often vary by age, but the biologics for eosinophilic esophagitis include medications like Dupixent, Dupilumab, proton pump inhibitors, and topical steroids. To help manage the condition, there is also the option of dietary therapy, in which you practice the six-food elimination diet (SFED), outlined below:

1. Wheat
The SFED diet has patients eliminate wheat from the diet, as it is a common allergen and food trigger for some conditions, especially eosinophilic esophagitis. Some substitutes for wheat ingredients in a meal include barley, oats, corn, potatoes, and beans.

2. Milk
Milk is another top allergen and food trigger for a variety of conditions—so much so that it is often recommended you eliminate dairy and wheat first on this list of foods. Milk goes hand in hand with all dairy products, but luckily there are many dairy substitutes made with bases like almond milk, oat milk, coconut milk, and rice milk.

3. Egg
Another common allergen and trigger are eggs, earning them a spot on this list of foods to eliminate. While they are a great source of nutrients, you can substitute them for alternatives in cooking and baking with items like applesauce, mashed banana, yogurt, buttermilk, ground flaxseed or chia seed, and more.

4. Nuts
Many schools are nut-free due to the common allergy to them—the top nut allergies are towards peanuts, walnuts, almonds, cashews, pecans, and pistachios. If you still crave that crunch, you can try replacing them with seeds like pumpkin seeds, sunflower seeds, hemp seeds, chia seeds, and more.

5. Soy
Many individuals have issues with soy allergies and sensitivities, which is why they are another food to be eliminated in this diet. Soy is found in many items, such as infant formulas, canned broths, soups, canned tuna, baked goods, processed meats, energy bars, and more—be sure to check the labels of every food before consuming.

6. Shellfish
Lastly, shellfish is another common allergy and sensitivity that can cause undesirable reactions. Foods that fall under the category of a shellfish allergy include shrimp, crabs, lobster, squid, oysters, scallops, and snails, making it a good idea to avoid seafood almost entirely during the SFED diet.

The six food elimination diet was proposed by a gastroenterologist due to limited access to allergists that perform food allergy evaluations for eosinophilic esophagitis. The diet was so successful that it resulted in an 88% resolution of diseases in children with the condition. However, you should keep in mind that the diet is quite challenging to follow as major changes in eating habits will need to occur. Before beginning the SFED diet, be sure to speak to your healthcare team to make sure it’s right for you.