We first recognised eosinophilic oesophagitis in paediatric medicine affecting boys more than girls and in that setting early data suggested that implementing an elimination diet to exclude foodstuffs such as peanuts, eggs, soy, cow’s milk, wheat and tree nuts was effective in about 75% of all children treated. This seems to be less effective in adults. However these elimination diets need to be applied with vigour and preferably with the assistance of a dietician. The second approach is to use topical glucocorticoids most frequently fluticasone which is administered using the metered dose inhaler but removing the spacer. The medication is sprayed onto the patient’s mouth at the back of the tongue and swallowed with a small amount of fluid. Obviously it is not inhaled. Budesonide has also been used as a viscous slurry. The addition of a proton pump inhibitor is often used although the relationship between gastro-oesophageal reflux disease and eosinophilic oesophagitis is somewhat unclear. There does at times seem to be overlap and the two approaches to treatment can be synergistic.