Cost and accessibility of empiric food elimination diets for treatment of eosinophilic oesophagitis

Nutr Diet. 2022 Apr;79(2):238-246. doi: 10.1111/1747-0080.12717. Epub 2021 Dec 19.


Aim: This study aimed to investigate and compare the cost, affordability, and accessibility of three elimination diet approaches for the treatment of patients with eosinophilic esophagitis: the two-, four- and six-food elimination diets and with comparison to a standard diet.

Methods: An evidence-based modelling process was undertaken for costing and accessibility, including the development of three hypothetical reference families; four food baskets were modified from an established benchmark for each diet. Baskets were costed across eastern Melbourne, Australia. Affordability was modelled using two incomes: the equivalised disposable household income and welfare payments for reference families. Affordability was defined as <30% of the median weekly household income and food stress defined as >25% of a median weekly household income.

Results: All elimination diets were significantly more expensive than a standard diet and may be unaffordable for those receiving welfare. Prices significantly increased as the number of food allergens eliminated increased. Most items for a two-food elimination diet were available at major supermarkets; however, items for nutritionally complete four- and six-food elimination diets required a visit to a second store.

Conclusion: A step-up approach, commencing with a two-food elimination diet, instead of starting with a six-food elimination diet, may alleviate affordability barriers for most family types, which may enhance compliance. Clinicians should consider family type, financial situation, as well as accessibility of allergen-free foods in the patient's residential area when deciding on the most appropriate dietary or therapeutic treatment approach for eosinophilic oesophagitis.

Keywords: allergy; chronic disease management; clinical nutrition and dietetics; dietary intake; eosinophilic oesophagitis; food prices.

MeSH terms

  • Costs and Cost Analysis
  • Diet
  • Eosinophilic Esophagitis*
  • Food
  • Humans
  • Income