{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:02:36Z","timestamp":1789707756799,"version":"4.0.1"},"reference-count":29,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Med. Sci.","Medical Sciences"],"abstract":"<jats:p>Background\/Objectives: Dietary management, particularly through food elimination, has emerged as an effective therapeutic strategy for eosinophilic esophagitis (EoE). In this context, a one-food elimination diet (1-FED) targeting cow\u2019s milk has been proposed as a targeted and less restrictive alternative to broader elimination approaches. The aim of this systematic review and meta-analysis was to systematically assess the effectiveness of 1-FED in achieving histological remission and to compare its efficacy with broader elimination diets in patients with EoE. Methods: A systematic review of the literature was conducted across five databases (PubMed, Scopus, CINAHL, MEDLINE, and ClinicalTrials.gov). The primary endpoint was histological remission (&lt;15 eosinophils\/HPF). Comparative studies were pooled using a random-effects meta-analysis. Results: Eight studies met the eligibility criteria for the systematic review, of which seven were included in the meta-analysis. Overall, 156 of 306 patients achieved histological remission following 1-FED, corresponding to a pooled remission rate of 51% (95% CI: 43\u201360%). Histological remission rates ranged from approximately 34% to 65% across individual studies. Compared with broader elimination diets, 1-FED showed no significant difference in histological remission (OR 1.00, 95% CI 0.64\u20131.58; p = 0.99). Conclusions: Compared to multi-food elimination diets, 1-FED requires a less restrictive dietary pattern, which may offer practical advantages for treatment adherence in routine clinical practice, although this was not systematically or objectively measured in the included studies. The findings lend preliminary support to a step-up dietary strategy, in which 1-FED may be considered as an initial intervention and broader elimination diets are reserved for patients who fail to achieve remission.<\/jats:p>","DOI":"10.3390\/medsci14050575","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T16:07:29Z","timestamp":1789574849000},"page":"575","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is Milk Elimination Enough? A Systematic Review and Meta-Analysis of One-Food Elimination Diet in Eosinophilic Esophagitis"],"prefix":"10.3390","volume":"14","author":[{"given":"Stefani","family":"Tsaggaridou","sequence":"first","affiliation":[{"name":"Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8935-278X","authenticated-orcid":false,"given":"Constantinos","family":"Pitsios","sequence":"additional","affiliation":[{"name":"Medical School, University of Cyprus, Aglantzia 1056, Nicosia, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1007\/BF01296781","article-title":"Esophageal eosinophilia with dysphagia: A distinct clinicopathology syndrome","volume":"38","author":"Attwood","year":"1993","journal-title":"Dig. Dis. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1038\/ajg.2013.71","article-title":"ACG clinical guideline: Evidence-based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE)","volume":"108","author":"Dellon","year":"2013","journal-title":"Am. J. Gastroenterol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1053\/j.gastro.2017.06.067","article-title":"Epidemiology and natural history of eosinophilic esophagitis","volume":"154","author":"Dellon","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3270","DOI":"10.1016\/j.cgh.2023.06.005","article-title":"Global incidence and prevalence of eosinophilic esophagitis, 1976\u20132022: A systematic review and meta-analysis","volume":"21","author":"Hahn","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kanikowska, A., Hryhorowicz, S., Rychter, A.M., Kucharski, M.A., Zawada, A., Iwanik, K., Eder, P., S\u0142omski, R., Dobrowolska, A., and Krela-Ka\u017amierczak, I. (2021). Immunogenetic, molecular and microbiotic determinants of eosinophilic esophagitis and clinical practice: A new perspective of an old disease. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms221910830"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s11894-026-01036-3","article-title":"Dietary therapy in eosinophilic esophagitis (EoE): A practical approach to elimination","volume":"28","author":"Perananthan","year":"2026","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Pitsios, C., Vassilopoulou, E., Pantavou, K., Terreehorst, I., Nowak-Wegzryn, A., Cianferoni, A., Tsigkrelis, G.P., Papachristodoulou, M., Bonovas, S., and Nikolopoulos, G.K. (2022). Allergy-test-based elimination diets for the treatment of eosinophilic esophagitis: A systematic review of their efficacy. J. Clin. Med., 11.","DOI":"10.2139\/ssrn.4042682"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.jaci.2018.02.028","article-title":"Dietary therapy for eosinophilic esophagitis","volume":"142","author":"Lucendo","year":"2018","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1016\/j.cgh.2006.05.026","article-title":"Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis","volume":"4","author":"Kagalwalla","year":"2006","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1016\/j.cgh.2021.03.049","article-title":"A single-food milk elimination diet is effective for treatment of eosinophilic esophagitis in children","volume":"20","author":"Wechsler","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/S2468-1253(23)00012-2","article-title":"One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: A multicentre, randomised, open-label trial","volume":"8","author":"Kliewer","year":"2023","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1136\/bmj.327.7414.557","article-title":"Measuring inconsistency in meta-analyses","volume":"327","author":"Higgins","year":"2003","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1097\/MPG.0b013e318268da40","article-title":"Cow\u2019s milk elimination: A novel dietary approach to treat eosinophilic esophagitis","volume":"55","author":"Kagalwalla","year":"2012","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1111\/dote.12339","article-title":"Prospective, comparative effectiveness trial of cow\u2019s milk elimination and swallowed fluticasone for pediatric eosinophilic esophagitis","volume":"29","author":"Kruszewski","year":"2016","journal-title":"Dis. Esophagus"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1093\/jcag\/gwy030","article-title":"Liberalized versus strict cow\u2019s milk elimination for the treatment of children with eosinophilic esophagitis","volume":"2","author":"Teoh","year":"2019","journal-title":"J. Can. Assoc. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"79","DOI":"10.5223\/pghn.2020.23.1.79","article-title":"Efficacy of dairy-free diet and six-food elimination diet as initial therapy for pediatric eosinophilic esophagitis: A retrospective single-center study","volume":"23","author":"Wong","year":"2020","journal-title":"Pediatr. Gastroenterol. Hepatol. Nutr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.jaci.2016.01.048","article-title":"IgE antibodies and response to cow\u2019s milk elimination diet in pediatric eosinophilic esophagitis","volume":"138","author":"Erwin","year":"2016","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.jaci.2024.08.023","article-title":"One-food versus 4-food elimination diet for pediatric eosinophilic esophagitis: A multisite randomized trial","volume":"155","author":"Kliewer","year":"2025","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.anai.2017.11.006","article-title":"Elevated expression of activated TH2 cells and milk-specific TH2 cells in milk-induced eosinophilic esophagitis","volume":"120","author":"Cianferoni","year":"2018","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2406","DOI":"10.1007\/s10620-023-07924-2","article-title":"Food-specific IgG4 is elevated throughout the upper gastrointestinal tract in eosinophilic esophagitis","volume":"68","author":"Masuda","year":"2023","journal-title":"Dig. Dis. Sci."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1002\/jpn3.12084","article-title":"Granzyme B is elevated in esophageal biopsies from children with eosinophilic esophagitis","volume":"78","author":"Thulin","year":"2024","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1002\/ncp.11117","article-title":"Single-food elimination of cow\u2019s milk as a treatment for eosinophilic esophagitis in children aged 2\u201318 years: A review of the literature","volume":"39","author":"Grasso","year":"2024","journal-title":"Nutr. Clin. Pract."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1016\/j.cgh.2017.05.048","article-title":"Efficacy of a 4-food elimination diet for children with eosinophilic esophagitis","volume":"15","author":"Kagalwalla","year":"2017","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1016\/j.cgh.2023.01.019","article-title":"Efficacy of elimination diets in eosinophilic esophagitis: A systematic review and meta-analysis","volume":"21","author":"Mayerhofer","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Arias, \u00c1., Terreehorst-Mu\u00f1oz, A., Guti\u00e9rrez-Ram\u00edrez, L., Molina-Infante, J., and Lucendo, A.J. (2024). Efficacy of dietary therapy for eosinophilic esophagitis in children and adults: An updated systematic review and meta-analysis. Nutrients, 16.","DOI":"10.3390\/nu16142231"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"De Vlieger, L., Smolders, L., Nuyttens, L., Verelst, S., Breynaert, C., Vanuytsel, T., Hoffman, I., and Bullens, D.M.A. (2021). A clinical perspective on the dietary therapies for pediatric eosinophilic esophagitis: The gap between research and daily practice. Front. Immunol., 12.","DOI":"10.3389\/fimmu.2021.677859"}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/5\/575\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:18:11Z","timestamp":1789705091000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/5\/575"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":29,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["medsci14050575"],"URL":"https:\/\/doi.org\/10.3390\/medsci14050575","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]}}}