Atopy patch test in children with cow’s milk and hen’s egg allergy: Do clinical symptoms matter?
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Keywords
Atopy patch test, Cow’s milk allergy, Hen’s egg allergy, Children
Abstract
Introduction and objectives: Since early 2000s, atopy patch test (APT) has been used to determine non-IgE and mixed-type food allergies. Previous studies have reported conflicting results about the diagnostic value of APT in food allergies, due to non-standardized methods.
We aimed to determine the diagnostic efficacy of APT compared to open oral food challenge (OFC) in patients diagnosed with cow’s milk allergy (CMA) and hen’s egg allergy (HEA) manifesting as atopic dermatitis (AD) and gastrointestinal system symptoms.
Materials and methods: In patients with suspected AD and/or gastrointestinal manifestations due to CMA and HEA, the results of OFC, APT, skin prick test (SPT) and specific IgE (sIgE) were reviewed. Specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of sIgE, SPT, APT and SPT + APT were calculated.
Results: In total 133 patients with suspected CMA (80) and HEA (53) were included in the study. In patients with CMA presenting with gastrointestinal symptoms, APT had sensitivity of 9.1%, specificity of 100%, PPV of 100% and NPV of 48.7%. In atopic dermatitis patients, sensitivity of APT was 71.4%, specificity 90.6%, PPV 62.5% and NPV 93.6%.
In patients diagnosed with HEA, the sensitivity, specificity, PPV and NPV values of APT were 72.0%, 78.6%, 47.2% and 75.0%, respectively. In patients diagnosed with HEA presenting with AD, sensitivity of APT was 87.5%, specificity 70.6%, PPV 73.7% and NPV 85.7%. Atopy patch test had lower sensitivity (44.4%) and higher specificity (90.9%) in patients diagnosed with HEA presenting with gastrointestinal symptoms than those presenting with AD.
Conclusion: Our study showed that APT provided reliable diagnostic accuracy in atopic dermatitis patients. However, APT had low sensitivity in patients with gastrointestinal symptoms.
References
2. Sicherer SH, Wood RA, Vickery BP, Jones SM, Liu AH, Fleischer DM, et al. The natural history of egg allergy in an observational cohort. J Allergy Clin Immunol. 2014;133:492-9.
3. Nwaru BI, Hickstein L, Panesar SS, Roberts G, Muraro A, Sheikh A, et al. Prevalence of common food allergies in Europe: a systematic review and meta-analysis. Allergy. 2014;69:992-1007.
4. Sampson HA, Aceves S, Bock SA, James J, Jones S, Lang D, et al. Food allergy: a practice parameter update -2014. J Allergy Clin Immunol. 2014;134, 1016-25.e43.
5. Costa AJF, Sarinho ESC, Motta MEFA, Gomes PN, De Oliveira De Melo SM, Da Silva GAP. Allergy to cow’s milk proteins: what contribution does hypersensitivity in skin tests have to this diagnosis? Pediatr Allergy Immunol. 2011;22:e133-8.
6. Strömberg L. Diagnostic accuracy of the atopy patch test and the skin-prick test for the diagnosis of food allergy in young children with atopic eczema/dermatitis syndrome. Acta Paediatr. 2002;91:1044-9.
7. 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;30:451-61.
8. Bock A, Sampson HA. Evaluation of food allergy. In: Leung DYM, Szefler SJ, Akdis CA, Sampson H, Bonilla FA, editors. Pediatric allergy: principles and practice. 3rd ed. New York: Elsevier; 2016. p. 371-6.
9. Jesenák M, Bánovcin P. Atopy patch test in the diagnosis of food allergy in children with atopic dermatitis. Acta Medica (Hradec
Kralove). 2006;49:199-201.
10. Davis MD, Scalf LA, Yiannias JA, Cheng JF, El-Azhary RA, Rohlinger AL, et al. Changing trends and allergens in the patch test standard series: a mayo clinic 5-year retrospective review, January 1, 2001, through December 31, 2005. Arch Dermatol. 2008;144:67-72.
11. Nowak-Wegrzyn A, Assa’ad AH, Bahna SL, Bock SA, Sicherer SH, Teuber SS, et al. Work Group report: oral food challenge testing. J Allergy Clin Immunol. 2009;123 Suppl.:S365-83.
12. Cudowska B, Kaczmarski M. Atopy patch test in the diagnosis of food allergy in children with gastrointestinal symptoms. Adv Med Sci. 2010;55:153-60.
13. Canani RB, Buongiovanni A, Nocerino R, Cosenza L, Troncone R. Toward a standardized reading of the atopy patch test in children with suspected cow’s milk allergy-related gastrointestinal symptoms. Allergy. 2011;66:1499-500.
14. 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;46:241-6.
15. Caglayan Sozmen S, Povesi Dascola C, Gioia E, Mastrorilli C, Rizzuti L, Caffarelli C. Diagnostic accuracy of patch test in children with food allergy. Pediatr Allergy Immunol. 2015;26:416-22.
16. Mansouri M, Rafiee E, Darougar S, Mesdaghi M, Chavoshzadeh Z. Is the atopy patch test reliable in the evaluation of food allergy related atopic dermatitis? Int Arch Allergy Immunol. 2018;175:85-90.
17. Kwon WJ, Ko JY, Ro YS, Kim MH, Kim BS, Kim HO, et al. Comparison of allergen responses based on the TRUE Test and IQ Chamber system in Korean patients. Eur J Dermatol. 2017;27:573-8.
18. 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;110:515-6.
19. Visitsunthorn N, Chatpornvorarux S, Pacharn P, Jirapongsananuruk O. Atopy patch test in children with atopic dermatitis. Ann Allergy Asthma Immunol. 2016;117:668-73.
20. Boonyaviwat O, Pacharn P, Jirapongsananuruk O, Vichyanond P, Visitsunthorn N. Role of atopy patch test for diagnosis of food allergy-related gastrointestinal symptoms in children. Pediatr Allergy Immunol. 2015;26:737-41.
21. Borrelli O, Barbara G, Di Nardo G, Cremon C, Lucarelli S, Frediani T, et al. Neuroimmune interaction and anorectal motility in children with food allergy-related chronic constipation. Am J Gastroenterol. 2009;104:454-63.
22. Turunen S, Karttunen TJ, Kokkonen J. Lymphoid nodular hyperplasia and cow’s milk hypersensitivity in children with chronic constipation. J Pediatr. 2004;145:606-11.
23. Caubet JC, Nowak-Wegrzyn ˛ A. Current understanding of the immune mechanisms of food protein-induced enterocolitis syndrome. Expert Rev Clin Immunol. 2011;7:317-27.
24. Chung HL, Hwang JB, Park JJ, Kim SG. Expression of transforming growth factor beta1, transforming growth factor type I and II receptors, and TNF-alpha in the mucosa of the small intestine in infants with food protein-induced enterocolitis syndrome. J Allergy Clin Immunol. 2002;109: 150-4.
25. Canani RB, Ruotolo S, Auricchio L, Caldore M, Porcaro F, Manguso F, et al. Diagnostic accuracy of the atopy patch test in children with food allergy-related gastrointestinal symptoms. Allergy. 2007;62:738-43.
26. Chung BY, Kim HO, Park CW, Lee CH. 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. Ann Dermatol. 2010;22:404-11.
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