Ann Dermatol.  2010 Nov;22(4):404-411. 10.5021/ad.2010.22.4.404.

Diagnostic Usefulness of the Serum-Specific IgE, the Skin Prick Test and the Atopy Patch Test Compared with That of the Oral Food Challenge Test

Affiliations
  • 1Department of Dermatology, College of Medicine, Hallym University, Kangnam Sacred Heart Hospital, Seoul, Korea. dermap@paran.com

Abstract

BACKGROUND
Atopic dermatitis (AD) is frequently associated with food allergies. In addition to the skin prick test (SPT) and serum-specific IgE, the atopy patch test (APT) has been introduced as a diagnostic procedure for food allergies.
OBJECTIVE
Our aim was to evaluate the diagnostic value of the APT, the SPT and the serum-specific IgE levels compared with that of oral food challenge test against milk and egg in AD patients.
METHODS
We conducted the SPT and APT, and determined the serum-specific IgE levels against milk and egg antigens for 101 patients. Oral food challenge tests were conducted for 86 out of 101 AD patients. The sensitivity, specificity and positive and negative predictable values were calculated for all the tests.
RESULTS
Twenty-five patients were positive to oral food challenges. The sensitivity of the APT for milk was 66.7%, while the figures for the SPT and the serum-specific IgE were 35.5% and 14.2%. The sensitivity of the APT for egg was 50%, while that for the SPT and serum-specific IgE were 21.4% and 6.7%.
CONCLUSION
We were able to conclude that the APT test seems to be a valuable additional tool for the diagnostic method of food allergies in AD.

Keyword

Atopic; Dermatitis; Food hypersensitivity; Predictive value of tests; Sensitivity and specificity; Skin tests

MeSH Terms

Dermatitis
Dermatitis, Atopic
Dimaprit
Food Hypersensitivity
Humans
Immunoglobulin E
Milk
Ovum
Patch Tests
Predictive Value of Tests
Sensitivity and Specificity
Skin
Skin Tests
Dimaprit
Immunoglobulin E

Reference

1. Schultz Larsen F, Hanifin JM. Epidemiology of atopic dermatitis. Immunol Allergy Clin North Am. 2002. 22:1–24.
Article
2. Eichenfield LF, Hanifin JM, Luger TA, Stevens SR, Pride HB. Consensus conference on pediatric atopic dermatitis. J Am Acad Dermatol. 2003. 49:1088–1095.
Article
3. Burks AW, Mallory SB, Williams LW, Shirrell MA. Atopic dermatitis: clinical relevance of food hypersensitivity reactions. J Pediatr. 1988. 113:447–451.
Article
4. Sampson HA. Food allergy. Part 1: immunopathogenesis and clinical disorders. J Allergy Clin Immunol. 1999. 103:717–728.
Article
5. Sicherer SH, Sampson HA. Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol. 1999. 104:S114–S122.
Article
6. Burks AW, James JM, Hiegel A, Wilson G, Wheeler JG, Jones SM, et al. Atopic dermatitis and food hypersensitivity reactions. J Pediatr. 1998. 132:132–136.
Article
7. Host A, Halken S. A prospective study of cow milk allergy in Danish infants during the first 3 years of life. Clinical course in relation to clinical and immunological type of hypersensitivity reaction. Allergy. 1990. 45:587–596.
Article
8. Bock SA. Prospective appraisal of complaints of adverse reactions to foods in children during the first 3 years of life. Pediatrics. 1987. 79:683–688.
Article
9. Niggemann B, Sielaff B, Beyer K, Binder C, Wahn U. Outcome of double-blind, placebo-controlled food challenge tests in 107 children with atopic dermatitis. Clin Exp Allergy. 1999. 29:91–96.
Article
10. Mitchell EB, Crow J, Chapman MD, Jouhal SS, Pope FM, Platts-Mills TA. Basophils in allergen-induced patch test sites in atopic dermatitis. Lancet. 1982. 1:127–130.
Article
11. Chang DS, Seo SJ, Hong CK. Patch test and specific IgE level with food antigens in atopic dermatitis patients. Korean J Dermatol. 2002. 40:1028–1034.
12. Leung DYM, Eichenfield LF, Boguniewicz M. Freedberg IM, Eisen AZ, Wolff K, Austen KF, Goldsmith LA, Karz SI, editors. Atopic dermatitis. Fitzpatrick's dermatology in general medicine. 2003. 6th ed. New York: McGraw-Hill;1180–1194.
13. Hanifin JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereol (Stockh). 1980. 92:Suppl. 44–47.
14. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993. 186:23–31.
15. Bindslev-Jensen C, Ballmer-Weber BK, Bengtsson U, Blanco C, Ebner C, Hourihane J, et al. Standardization of food challenges in patients with immediate reactions to foods-position paper from the European Academy of Allergology and Clinical Immunology. Allergy. 2004. 59:690–697.
Article
16. Roehr CC, Reibel S, Ziegert M, Sommerfeld C, Wahn U, Niggemann B. Atopy patch tests, together with determination of specific IgE levels, reduce the need for oral food challenges in children with atopic dermatitis. J Allergy Clin Immunol. 2001. 107:548–553.
Article
17. Osterballe M, Andersen KE, Bindslev-Jensen C. The diagnostic accuracy of the atopy patch test in diagnosing hypersensitivity to cow's milk and hen's egg in unselected children with and without atopic dermatitis. J Am Acad Dermatol. 2004. 51:556–562.
Article
18. Saxon A. Lawlor GJ, Fischer TJ, editors. Immediate hypersensitivity: approach to diagnosis. Manual of allergy and immunology: diagnosis and therapy. 1988. 2nd ed. Boston: Little-Brown;29–30.
19. Isolauri E, Turjanmaa K. Combined skin prick and patch testing enhances identification of food allergy in infants with atopic dermatitis. J Allergy Clin Immunol. 1996. 97:9–15.
Article
20. Yim YS, Park CW, Lee CH. A comparative study of atopy patch test using house dust mite antigens with skin prick test and specific serum IgE level in atopic dermatitis. Korean J Dermatol. 2001. 39:1072–1079.
21. Rawle FC, Mitchell EB, Platts-Mills TA. T cell responses to the major allergen from the house dust mite Dermatophagoides pteronyssinus, Antigen P1: comparison of patients with asthma, atopic dermatitis, and perennial rhinitis. J Immunol. 1984. 133:195–201.
22. Niggemann B, Ziegert M, Reibel S. Importance of chamber size for the outcome of atopy patch testing in children with atopic dermatitis and food allergy. J Allergy Clin Immunol. 2002. 110:515–516.
Article
Full Text Links
  • AD
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr