Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder of the esophagus that, in a genetically susceptible host, is triggered by a food antigen. Emerging evidence supports impaired epithelia barrier function as the key initial event in the development of EoE and other allergic diseases. Symptom resolution, histologic remission, and prevention of both disease and treatment-related complications are the goals of treatment. Successful dietary treatments include elemental and elimination diets, both empiric and allergy test directed. These treatments are dietary approaches to inducing clinical and histologic remission. Dietary therapy with an exclusive elemental diet offers the best response with a remission rate of more than 96%. Empiric elimination diets and allergy-directed diets offer similar response with remission induced in 3 of 4 subjects (75%). Cow's milk, wheat, egg and soy are the four common food antigens most likely to induce esophageal inflammation.