1
|
Skin Tests for Immediate Hypersensitivity. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
2
|
Mortz CG, Bindslev-Jensen C. Skin Tests for Immediate Hypersensitivity. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_28-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
3
|
Luo Y, Zhang GQ, Li ZY. The diagnostic value of APT for food allergy in children: a systematic review and meta-analysis. Pediatr Allergy Immunol 2019; 30:451-461. [PMID: 30703250 DOI: 10.1111/pai.13031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND The role of atopy patch test (APT) in the diagnosis of food allergy (FA) remains largely controversial. In our meta-analysis, we aimed to evaluate the accuracy of APT for diagnosing FA in children. METHODS Pubmed, Embase and Cochrane Library were searched for studies regarding the diagnostic value of APT for FA in children compared to oral food challenge (double-blind placebo-controlled food challenge and/or open food challenge). The last search was conducted on November 11, 2017. Two reviewers independently screened relevant studies and assessed the quality by QUADAS-2. Meta-analysis was performed to calculate the pooled sensitivity, specificity, DOR (diagnostic odds ratio), PLR (positive likelihood ratio), NLR (negative likelihood ratio) with their 95% confidence intervals (CIs). Subgroup analyses were conducted according to different food allergens, atopic dermatitis, gastrointestinal symptoms, and age younger than 3 years. RESULTS Forty-one studies were included in the meta-analysis. The pooled sensitivity, specificity, PLR, NLR and DOR were 50.30% (95% CI 48.40%-52.30%), 86.60% (95% CI 85.30%-87.80%), 3.405 (95% CI 2.594-4.470), 0.545 (95% CI 0.469-0.634) and 7.528 (95% CI 5.507-11.206), respectively. However, for children with FA-related gastrointestinal symptoms, the pooled sensitivity and specificity were 57.40% (95% CI 52.10%-62.50%) and 91.50% (95% CI 88.30%-94.10%) respectively. CONCLUSIONS Our findings suggest that APT is specific but not sensitive for diagnosing FA in children, especially in children with FA-related gastrointestinal symptoms.
Collapse
Affiliation(s)
- Ying Luo
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Department of Gastroenterology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Guo-Qiang Zhang
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Department of Gastroenterology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhong-Yue Li
- Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Department of Gastroenterology, Children's Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
4
|
Gonzaga TA, Alves FA, Cheik MFA, de Barros CP, Rezende ERMA, Segundo GRS. Low efficacy of atopy patch test in predicting tolerance development in non-IgE-mediated cow's milk allergy. Allergol Immunopathol (Madr) 2018; 46:241-246. [PMID: 29031891 DOI: 10.1016/j.aller.2017.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/05/2017] [Accepted: 07/25/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The food atopy patch (APT) test has been used in previous studies to help the diagnosis of non-IgE mediated food allergies (FA). The aim of this study was to evaluate the efficacy of different cow's milk APT preparations to predict oral tolerance in children with previous non-IgE-mediated cow's milk allergy (CMA) diagnosis. METHODS Thirty-two patients non-IgE-mediated CMA diagnosed by oral food challenge (OFC) were enrolled to perform APT with three different cow's milk preparations (fresh, 2% in saline solution, 2% in petrolatum) and comparing with a new OFC after at least three months of diet exclusion. RESULTS Only six (18.7%) subjects presented positive OFC to cow's milk. No differences in gender, onset symptoms age, OFC age, Z-score, and exclusion period were found between positive and negative OFC patients. Preparations using fresh milk and powdered milk in petrolatum presented sensitivity equal to zero and specificity 92.3% and 96.1%. The preparation using powdered milk in saline solution showed sensitivity and specificity of 33.3% and 96.1%. Two patients presented typical IgE symptoms after OFC. CONCLUSION Cow's milk APT presented a low efficacy to predict tolerance in patients with previous non-IgE-mediated CMA and should not be used in clinical routine. The presence of typical IgE reactions after OFC hallmark the necessity of previous IgE-mediated investigation for this patient group.
Collapse
Affiliation(s)
- T A Gonzaga
- Food Allergy Research Group, Pediatrics Department, Universidade Federal de Uberlandia, Brazil
| | - F A Alves
- Food Allergy Research Group, Pediatrics Department, Universidade Federal de Uberlandia, Brazil
| | - M F A Cheik
- Food Allergy Research Group, Pediatrics Department, Universidade Federal de Uberlandia, Brazil
| | - C P de Barros
- Food Allergy Research Group, Pediatrics Department, Universidade Federal de Uberlandia, Brazil
| | - E R M A Rezende
- Food Allergy Research Group, Pediatrics Department, Universidade Federal de Uberlandia, Brazil
| | - G R S Segundo
- Food Allergy Research Group, Pediatrics Department, Universidade Federal de Uberlandia, Brazil.
| |
Collapse
|
5
|
Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches. J Am Acad Dermatol 2014; 71:1218-33. [PMID: 25264237 DOI: 10.1016/j.jaad.2014.08.038] [Citation(s) in RCA: 202] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/06/2014] [Accepted: 08/22/2014] [Indexed: 01/27/2023]
Abstract
Atopic dermatitis is a common, chronic inflammatory dermatosis that can affect all age groups. This evidence-based guideline addresses important clinical questions that arise in its management. In this final section, treatments for flare prevention and adjunctive and complementary therapies and approaches are reviewed. Suggestions on use are given based on available evidence.
Collapse
|
6
|
Roth-Walter F, Starkl P, Zuberbier T, Hummel K, Nöbauer K, Razzazi-Fazeli E, Brunner R, Pali-Schöll I, Kinkel J, Felix F, Jensen-Jarolim E, Kinaciyan T. Glutathione exposes sequential IgE-epitopes in ovomucoid relevant in persistent egg allergy. Mol Nutr Food Res 2013; 57:536-44. [PMID: 23349099 DOI: 10.1002/mnfr.201200612] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 10/30/2012] [Accepted: 11/13/2012] [Indexed: 11/06/2022]
Abstract
SCOPE Patients with persistent egg allergy have more immunoglobulin E (IgE) against sequential than conformational epitopes of ovomucoid (OVO). Here, we aimed to identify compounds capable to render sequential epitopes in egg. METHODS AND RESULTS Glutathione was used for in vitro reduction of OVO and circular dichroism analyses were performed. Glutathione reduced OVO in a concentration-dependent manner. Egg white was analyzed for reduced proteins with a thiol probe and by MALDI-TOF/TOF. In unprocessed total egg white, several reduced proteins were detected by the thiol probe, among them reduced ovalbumin could be confirmed with MS analyses. Egg-allergics or sensitized controls were tested serologically (n = 19) for IgE against native and reduced OVO and in skin prick tests (n = 9). More patients had IgE against reduced than native OVO in Western blots. In skin prick test, five out of seven persistent egg-allergics and none of the controls reacted with reduced OVO. CONCLUSION Reduced egg proteins are present in natural egg white. Glutathione, which is present in egg and furthermore is used as texture-improving additive in processed food, is capable of reducing OVO. Patients with persistent egg allergy reacted rather to reduce the native OVO. Hence, our data indicate that reduction is a novel natural and processing-associated principle, which contributes to the allergenicity of food.
Collapse
Affiliation(s)
- Franziska Roth-Walter
- Comparative Medicine, Messerli Research Institute, University of Veterinary Medicine Vienna, Vienna, Medical University of Vienna and University of Vienna, Austria
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Mehl A, Niggemann B, Keil T, Wahn U, Beyer K. Skin prick test and specific serum IgE in the diagnostic evaluation of suspected cow's milk and hen's egg allergy in children: does one replace the other? Clin Exp Allergy 2012; 42:1266-72. [PMID: 22805474 DOI: 10.1111/j.1365-2222.2012.04046.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The measurement of specific serum immunoglobulin E (sIgE) and the skin prick test (SPT) are accepted tools in the diagnostic work-up of suspected food allergy. Often only one of the methods is used to determine sensitization; however, it is still under debate whether these two methods can be used interchangeably. OBJECTIVES To investigate the concordance of SPT and sIgE serum assays with regard to suspected food allergy. METHODS In 395 children referred to our clinic with suspected cow's milk allergy and in 268 children with suspected hen's egg allergy specific immunoglobulin E (IgE) was measured, a SPT and an oral food challenge performed. A weal size ≥ 3 mm and sIgE ≥ 0.35 kU/L were considered positive. The weal size of the SPT and the level of food-specific IgE were tested for correlation for each allergen. RESULTS Of the 395 (23%) children orally challenged with cow's milk, 92 showed no corresponding results for SPT and sIgE as either positive or negative. For hen's egg, in 27 of 268 (10%) children differing test results for SPT and sIgE in serum were obtained. Moreover, regarding the quantitative values for sIgE and SPT in children with or without clinically relevant food allergy, sIgE and SPT correlated badly. CONCLUSIONS The concordance between SPT and sIgE is surprisingly low for cow's milk and hen's egg on an individual basis. Therefore, the tests should not be used interchangeably. Especially in children who receive a negative test result the alternative test should also be used. Furthermore, our data indicate again that oral food challenges are still the method of choice to diagnose food allergies.
Collapse
Affiliation(s)
- A Mehl
- Department of Pediatric Pneumology and Immunology, Charité University Medical Center, Berlin, Germany
| | | | | | | | | |
Collapse
|
8
|
|
9
|
Fadeeva T, Asin JLE, Horrillo ML, Baraut TG, Vela RFO, Conde SLR, Hontoria OE, Valero CB, Molina AMM. Results of the oral egg-challenge test performed on two different groups of children. One group with a history, suggestive of allergic reaction with egg intake and the other group sensitised to hen's egg without previous egg intake. Allergol Immunopathol (Madr) 2010; 38:233-40. [PMID: 20619526 DOI: 10.1016/j.aller.2010.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2009] [Revised: 01/03/2010] [Accepted: 01/09/2010] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Egg allergy is an adverse immune-system reaction of an IgE-mediated type, which can happen in children after egg intake and several times after their first egg intake. OBJECTIVES Compare the results of the oral egg-challenge test in two groups of egg-sensitised children, with and without prior intake. PATIENTS AND METHODS Retrospective study of two egg-sensitised groups (72 subjects). Group 1: 22 children without prior egg-intake. Group 2: 50 children with a clinical history of adverse reactions after egg intake. Skin prick tests, egg-white specific IgE (sIgE) and yolk specific IgE, were performed on all children. The oral egg-challenge tests were performed after a period of egg-avoidance diet and when egg-white specific IgE levels were lower than 1.5K U/L. RESULTS 31.8% of the children in Group 1 did not tolerate egg-intake whereas 38% of the children in Group 2 did not tolerate egg-intake. Egg-avoidance periods lasted 19.5 and 18 months, respectively. Egg-white specific IgE levels went down in both groups after an egg-avoidance diet. No statistically significant differences were found between the groups and the positivity of oral egg-challenge test. CONCLUSIONS No statistically significant differences were found in the behaviour of the two groups studied. Given the high risk of adverse reactions, it was recommended that any egg-introduction tests were to be performed in a hospital environment on the children who were sensitised to hen's egg (including children without prior egg intake).
Collapse
Affiliation(s)
- T Fadeeva
- The Maternity and Children's Vall d'Hebron Hospital, Allergy Department, Barcelona, Spain.
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
The diagnostic value of atopy patch testing and prick testing in atopic dermatitis: facts and controversies. Clin Dermatol 2010; 28:38-44. [PMID: 20082949 DOI: 10.1016/j.clindermatol.2009.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We conducted a systematic Medline search of the literature (1998-2008) on the criteria for performing the skin prick test and atopy patch testing (APT) to determine their utility in atopic dermatitis (AD). The skin prick, scratch, and skin patch tests are performed to identify which allergen is causing eczematous skin symptoms in patients with AD, or sneezing, nasal congestion, itchy eyes, wheezing, skin rash, and swelling. Many allergens in foods, drugs, and environmental substances (eg, ragweed and fungus), as well as contact allergens, can elicit eczematous skin reactions after epicutaneous application. Because no gold standard exists for aeroallergen provocation in AD, the APT is currently used to evaluate allergen without comparison with another accurate and reliable method. The APT is presumed to reflect delayed-phase clinical reactions. Even with delayed onset of symptoms (more than 2 hours after food ingestion), APT findings were not consistent among AD children. The APT could be used in children with gastrointestinal reactions to foods as well as AD. After standardization, the APT may provide further diagnostic information in addition to the skin prick test and serum immunoglobulin E values and may be able to evaluate the actual clinical relevance of immunoglobulin E-mediated sensitizations for eczematous lesions. The European APT model used with standardization of allergen concentration and vehicle may provide an important diagnostic tool to select patients for avoidance and for procedures of allergen-specific immunotherapy, but the clinical relevance of positive APT reactions awaits standardized provocation and avoidance testing.
Collapse
|
11
|
Jesenak M, Banovcin P, Rennerova Z, Jakusova L, Havlicekova Z, Pohanka V, Villa MP, Ronchetti R. Reproducibility of food atopy patch tests over time in the general child population. Int J Dermatol 2009; 48:941-6. [PMID: 19702976 DOI: 10.1111/j.1365-4632.2008.04037.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The atopy patch test (APT) is no longer an experimental method; it is increasingly being used as a standard diagnostic tool for the characterization of patients with aeroallergen- and food-triggered disorders. Some technical aspects of this test still remain to be answered. We aimed to study the reproducibility of this test over time in the general child population. METHODS In a general population of 118 children, we investigated the reproducibility of duplicate APTs with four food allergens in their native form, which were repeated at set intervals from the first test: 7 days (group 1), 14 days (group 2), and 21 days (group 3). RESULTS We observed very poor reproducibility on both sides of the back in all three studied subgroups. The reproducibility rates and Cohen's kappa values did not improve when we did not consider the side of the back. There were no differences in the prevalence of atopy between the subjects with reproducible and nonreproducible APT results. All three groups studied showed no difference in the prevalence rates of atopy. There was no relationship between APT and skin prick test positivity for the same allergen. Questionnaire-derived data about previous food-related reactions did not help in the evaluation of the doubtful nonreproducible APT results with food allergens. CONCLUSIONS Our results show that the reproducibility of food APTs is poor and unsatisfactory over time, and there is an urgent need for the development of optimal, stable, and good-quality APT testing substances.
Collapse
Affiliation(s)
- Milos Jesenak
- Department of Pediatrics, 2nd School of Medicine, University of La Sapienza, Rome, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Diéguez MC, Cerecedo I, Muriel A, Zamora J, Abraira V, Camacho E, Antón M, de la Hoz B. Utility of diagnostic tests in the follow-up of egg-allergic children. Clin Exp Allergy 2009; 39:1575-84. [DOI: 10.1111/j.1365-2222.2009.03299.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
13
|
Cocco R, Solé D. Patch test in the diagnosis of food allergy. Allergol Immunopathol (Madr) 2009; 37:205-7. [PMID: 19783345 DOI: 10.1016/j.aller.2009.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 03/01/2009] [Indexed: 10/20/2022]
Abstract
Double-blind, placebo-controlled food challenges (DBPCFC) are the gold standard method for diagnosing food allergies. However, due to the difficulty of their performance on routine clinic, there is a need for laboratory tools in order to minimise the frequency of DBPCFC. Atopy patch test (APT) represents a promising manner of diagnosing delayed-type allergic reactions. The APT may identify patients with food allergies with negative specific IgE. However, the clinical relevance of positive APT reactions is still to be proven by standardised outcome definitions.
Collapse
|
14
|
Ronchetti R, Jesenak M, Trubacova D, Pohanka V, Villa MP. Epidemiology of atopy patch tests with food and inhalant allergens in an unselected population of children. Pediatr Allergy Immunol 2008; 19:599-604. [PMID: 18312530 DOI: 10.1111/j.1399-3038.2007.00712.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Atopy patch test (APT) has been used as a diagnostic tool in patients with suspected food or inhalant allergy. This study assessed the prevalence of positive APT with food or inhalant allergens in an unselected population of schoolchildren. We also evaluated the link between positive APT reactions and skin-prick tests (SPT) for food and inhalant allergens, circulating eosinophils and histamine skin reactivity. We studied an unselected population of 380 children aged 9 or 13 yr living in Rome, Italy. APTs were carried out with food (native or standardized) and inhalant allergens. All the children also underwent skin-prick testing with five common inhalant and four food allergens. We also measured eosinophil cell counts and histamine skin reactivity. The prevalence of positive APT reactions for foods in unselected children ranged between 4% and 11% for hen's egg, tomato, and wheat flour and was similar for both age groups studied. The prevalence of positive APT for milk was significantly lower in children aged 13 than in children aged 9 (p = 0.013). No concordance emerged between positive APT and SPT for foods. Conversely, APT and SPT for inhalant allergens yielded statistically significant concordance (p < 0.001). APT produces positive reactions for food or inhalant allergens in a significant number of subjects in the general population of schoolchildren. Age influences the prevalence of positive APTs with cow's milk to some extent. Inhalant allergens probably induce a positive APT reaction through an immunoglobulin E-linked process, while food allergens probably do not.
Collapse
Affiliation(s)
- Roberto Ronchetti
- Department of Paediatrics, 2nd School of Medicine, University La Sapienza, Rome, Italy.
| | | | | | | | | |
Collapse
|
15
|
Jesenak M, Banovcin P, Rennerova Z, Havlicekova Z, Jakusova L, Ronchetti R. Side effects of food atopy patch tests. Clin Pediatr (Phila) 2008; 47:602-3. [PMID: 18566356 DOI: 10.1177/0009922808316993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Milos Jesenak
- Department of Pediatrics, Comenius University in Bratislava, Jessenius School of Medicine, Martin, Slovak Republic.
| | | | | | | | | | | |
Collapse
|
16
|
Diéguez MC, Cerecedo I, Muriel A, Zamora J, Sánchez-Cano M, De la Hoz B. Skin prick test predictive value on the outcome of a first known egg exposure in milk-allergic children. Pediatr Allergy Immunol 2008; 19:319-24. [PMID: 18482080 DOI: 10.1111/j.1399-3038.2007.00652.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Children with milk allergy have higher incidence of other food allergies, especially egg allergy. The objective of this study was to ascertain the accuracy of the prick test in children with IgE-mediated milk allergy for diagnosing egg allergy. Children under the age of 1 yr who came consecutively to Allergy Department 2003-05, and were diagnosed with IgE-mediated milk allergy were selected for this study. Egg introduction was completely avoided until the age of 14 months when clinical history, skin prick tests (SPT), specific-IgE antibodies determination and egg challenge test were performed. One hundred and four milk-allergic children were included. At least one positive prick test to any egg allergen was found in 65 out of the 104 (62.5%). Thirty-eight (36.5%) were allergic to egg proteins as well. Prick tests with egg white and ovomucoid (OVM) had the best diagnostic performances showing the largest areas under the receiver operating characteristic curve. The optimal diagnosis cut-off point was 6 mm for egg white and 5 mm for OVM. The positive likelihood ratios for these cut-off points were: 2.95 (95% CI: 1.74-4.99) for egg white prick test, and 20 (95% CI: 2.9-143.7) for OVM prick test. Children with specific IgE-mediated cow's milk allergy must be closely followed as a risk group for egg allergy. Early diagnosis is necessary and the SPT has shown itself to be a very useful tool for diagnosing immediate IgE reactions to egg on first known exposure.
Collapse
Affiliation(s)
- M C Diéguez
- Servicio de Alergología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
17
|
Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, Sicherer S, Golden DBK, Khan DA, Nicklas RA, Portnoy JM, Blessing-Moore J, Cox L, Lang DM, Oppenheimer J, Randolph CC, Schuller DE, Tilles SA, Wallace DV, Levetin E, Weber R. Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol 2008; 100:S1-148. [PMID: 18431959 DOI: 10.1016/s1081-1206(10)60305-5] [Citation(s) in RCA: 291] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
18
|
Cudowska B, Kaczmarski M. Atopowe testy płatkowe w diagnostyce alergii pokarmowej typu późnego u dzieci. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s0031-3939(08)70283-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Abstract
Egg allergy is one of the most common food allergies in infants and young children. The great majority is not life-threatening and management involves exclusion of egg from the diet and regular review with the expectation that the majority of children will outgrow the allergy by school age. Judgment is required as to when the dietary elimination of egg is no longer required. This decision may be helped by demonstrating loss of sensitivity by skin prick or specific IgE testing and in some cases a supervised food challenge. Particular issues in management arise with more severe, potentially life-threatening reactions, with immunization with vaccines prepared in eggs, with the diagnosis of egg hypersensitivity as a cause of delayed exacerbations of eczema which can be non-IgE mediated, and in deciding whether a child can be allowed to ingest small amounts of cooked egg through egg-containing foods while continuing to avoid raw egg or larger amounts of whole egg. Cases which illustrate these issues are presented.
Collapse
Affiliation(s)
- Andrew S Kemp
- Department of Allergy and Immunology, The Children's Hospital at Westmead, Sydney, Australia.
| |
Collapse
|
20
|
|
21
|
Asero R, Ballmer-Weber BK, Beyer K, Conti A, Dubakiene R, Fernandez-Rivas M, Hoffmann-Sommergruber K, Lidholm J, Mustakov T, Oude Elberink JNG, Pumphrey RSH, Stahl Skov P, van Ree R, Vlieg-Boerstra BJ, Hiller R, Hourihane JO, Kowalski M, Papadopoulos NG, Wal JM, Mills ENC, Vieths S. IgE-mediated food allergy diagnosis: Current status and new perspectives. Mol Nutr Food Res 2007; 51:135-47. [PMID: 17195271 DOI: 10.1002/mnfr.200600132] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In June 2005, the work of the EU Integrated Project EuroPrevall was started. EuroPrevall is the largest research project on food allergy ever performed in Europe. Major aims of the project are to generate for the first time reliable data on the prevalence of food allergies across Europe and on the natural course of food allergy development in infants. Improvement of in vitro diagnosis of food allergies is another important aim of the project. The present review summarizes current knowledge about the clinical presentation of food allergy and critically reviews available diagnostic tools at the beginning of the project period. A major problem in diagnosis is a relatively poor 'clinical specificity', i. e. both positive skin tests and in vitro tests for specific IgE are frequent in sensitized subjects without food allergy symptoms. So far, no in vitro test reliably predicts clinical food allergy. EuroPrevall aims at improving the predictive value of such tests by proceeding from diagnosis based on allergen extracts to purified allergen molecules, taking into account the affinity of the IgE-allergen interaction, and evaluating the potential of biological in vitro tests such as histamine release tests or basophil activation tests including assays performed with permanently growing cell lines.
Collapse
Affiliation(s)
- Riccardo Asero
- Ambulatorio di Allergologia, Clinica San Carlo, Paderno Dugnano, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Turjanmaa K, Darsow U, Niggemann B, Rancé F, Vanto T, Werfel T. EAACI/GA2LEN position paper: present status of the atopy patch test. Allergy 2006; 61:1377-84. [PMID: 17073865 DOI: 10.1111/j.1398-9995.2006.01136.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A number of scientific reports have been published on patch tests with protein allergens performed on patients with atopic eczema (AE). Evaluation of eczematous skin lesions with an atopy patch test (APT) can be used as a diagnostic tool in characterizing patients with aeroallergen- and food-triggered AE. Indications for testing with APT, choice of allergens (aeroallergens and foods), test materials and technique, including present knowledge on sensitivity and specificity, are reviewed on the basis of available literature. This position paper also points out the need for future research on the clinical use of the APT.
Collapse
Affiliation(s)
- K Turjanmaa
- Department of Dermatology, Tampere University Hospital, Tampere, Finland
| | | | | | | | | | | |
Collapse
|
23
|
Turjanmaa K. The role of atopy patch tests in the diagnosis of allergy in atopic dermatitis. Curr Opin Allergy Clin Immunol 2006; 5:425-8. [PMID: 16131918 DOI: 10.1097/01.all.0000182538.63273.a3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Recent literature on the atopy patch test, published since 2004, is reviewed to evaluate whether the pathomechanism of the test has become more evident and whether previous studies require standardization. RECENT FINDINGS There is evidence accumulating that a smaller subset of patients with atopic dermatitis show only atopy patch test positivity while specific IgE to the same allergen remains negative. It is possible that local IgE-mediated reactions occur in the skin. New data bring us a step forward in understanding the role of the atopy patch test in diagnosis of allergy in atopic dermatitis but no comprehensive studies were published during the period reviewed. SUMMARY Despite recent advances in determining the value and indication for use of the atopy patch test in atopic dermatitis, more objective studies are needed. The atopy patch test may be useful in understanding the mechanisms of atopic allergy, and in defining the clinical relevance of the airborne allergens in eliciting dermatitis. Regarding food allergy, the atopy patch test still requires standardization. To date, methodology differs in all published papers; even the gold standard, the challenge test itself, is not appropriately standardized, which makes the interpretation of results less reliable.
Collapse
|
24
|
Pereira B, Venter C, Grundy J, Clayton CB, Arshad SH, Dean T. Prevalence of sensitization to food allergens, reported adverse reaction to foods, food avoidance, and food hypersensitivity among teenagers. J Allergy Clin Immunol 2005; 116:884-92. [PMID: 16210065 DOI: 10.1016/j.jaci.2005.05.047] [Citation(s) in RCA: 166] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2005] [Revised: 05/25/2005] [Accepted: 05/26/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is a paucity of information on food hypersensitivity (FHS) among teenagers. OBJECTIVES We sought to investigate the sensitization rates, perception of FHS, food avoidance, and FHS assessed by means of food challenges among teenagers. METHODS This cohort study recruited 757 eleven-year-olds and 775 fifteen-year-olds in the United Kingdom. Sensitization rates, reported rates of FHS, and rates of food avoidance were measured. The prevalence of FHS was established by using food challenges. RESULTS The prevalence of reported FHS among the 11- and 15-year-old cohorts was 11.6% (90/775) and 12.4% (94/757), respectively. One hundred twenty-two (15.7%) and 142 (18.7%) of the 11- and 15-year-olds reported they were avoiding some food. The rates of sensitization to the food allergens were 5.1% (36/699) and 4.9% (32/649) for the 11- and 15-year-olds, respectively. FHS was confirmed in 8 (1.0%) 11-year-old children and 8 (1.0%) 15-year-old children by means of open food challenge and in 1 (0.1%) 11-year-old and 4 (0.5%) 15-year-olds by means of double-blind, placebo-controlled food challenge. The prevalence of FHS, as confirmed by using open food challenges and positive skin prick test responses plus a history of adverse reactions, was 18 (2.3%) of 775 in the 11-year-old cohort and 17 (2.3%) of 757 in the 15-year-old cohort. CONCLUSIONS The rate of reported FHS was significantly more than sensitization to the predetermined allergens (odds ratio, 2.17; 95% CI, 1.47-3.18; P < .001 in the 11-year-olds; odds ratio, 2.73; 95% CI, 1.81-4.13; P < .001 in the 15-year-olds). By means of objective assessment, 2.3% of both 11- and 15-year-old children had FHS, with the majority showing immediate reactions.
Collapse
Affiliation(s)
- Brett Pereira
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, United Kingdom
| | | | | | | | | | | |
Collapse
|
25
|
Abstract
PURPOSE OF REVIEW The accurate diagnosis of food allergy is crucial not only for the right treatment but also for the avoidance of unnecessary diets. The diagnostic work-up of suspected food allergy includes the measurement of food-specific IgE antibodies using serologic assays, the skin prick test, elimination diets and oral provocation tests. In addition, some approaches are either under further rigorous investigation (the atopy patch test) or are already in widespread use, particularly by practitioners of alternative or complementary medicine, but are considered unproven. These diagnostic methods include specific IgG to foods, provocation/neutralization testing, kinesiology, cytotoxic tests and electrodermal testing. This review covers some of the most common scientifically validated and unproven approaches used in the diagnosis of food allergy. RECENT FINDINGS For specific serum IgE and the SPT, decision points have been established for some foods, allowing prediction of clinical relevance. The APT may be helpful, especially when considered in combination with defined levels of specific IgE. In regard to other approaches, most scientific studies do refute the usefulness of these approaches. SUMMARY In most patients, controlled oral food challenges remain the gold standard in the diagnostic work-up of suspected food allergy. The skin prick test and measurement of specific IgE antibodies to food extracts, individual allergens or allergenic peptides are helpful in the diagnostic approach. Food-specific IgG continues to be an unproven or experimental test. The other alternative and complementary techniques have no proven benefit and may endanger patients via misdiagnosis.
Collapse
Affiliation(s)
- Kirsten Beyer
- Children's Hospital Charité, Humboldt University, Berlin, Germany.
| | | |
Collapse
|
26
|
Current World Literature. Curr Opin Allergy Clin Immunol 2005. [DOI: 10.1097/01.all.0000168798.22110.c9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|