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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(3):548-53JA

Abstract

BACKGROUND

Atopic dermatitis is commonly associated with food allergy. In addition to skin prick tests (SPTs) and measurements of specific IgE levels, the atopy patch test (APT) has recently been introduced into the diagnostic procedure for food allergy.

OBJECTIVE

Our aim was to evaluate whether a combination of allergologic tests could improve the prognostic value of the individual tests for positive food challenge results. We hypothesized that the combination of a positive APT result plus proof of specific IgE, a positive SPT result, or both would render double-blind, placebo-controlled, food challenges unnecessary.

METHODS

One hundred seventy-three double-blind, placebo-controlled, food challenges were performed in 98 children (median age, 13 months) with atopic dermatitis. All children were subjected to SPTs, APTs, and determination of specific IgE. Sensitivity, specificity, and positive and negative predictive values were calculated.

RESULTS

Ninety-five (55%) of 173 oral provocations were assessed as positive. For evaluating suspected cow's milk (CM) allergy, the APT was the best single predictive test (positive predictive value [PPV], 95%), and the combination of a positive APT result with evidence of specific IgE or an APT result together with a positive skin prick test response optimized the PPV to 100%. For hen's egg (HE) allergy, the APT was also the best single predictive test (PPV, 94%). The combination of 2 or more tests did not exceed the APT's predictive value. In both CM and HE challenges, the predictability of oral challenges depended on the level of specific IgE. For wheat allergy, the APT proved to be the most reliable test, and the PPV of 94% could not be improved by a combination with other allergologic tests.

CONCLUSION

The combination of positive APT results and measurement of levels of specific IgE (CM, > or = 0.35 kU/L; HE, > or = 17.5 kU/L) makes double-blind, placebo-controlled, food challenges superfluous for suspected CM and HE allergy.

Authors+Show Affiliations

Department of Pneumology and Immunology, University Children's Hospital Charité of Humboldt University, Berlin, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11240959

Citation

Roehr, C C., et al. "Atopy Patch Tests, Together With Determination of Specific IgE Levels, Reduce the Need for Oral Food Challenges in Children With Atopic Dermatitis." The Journal of Allergy and Clinical Immunology, vol. 107, no. 3, 2001, pp. 548-53.
Roehr CC, Reibel S, Ziegert M, et al. 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(3):548-53.
Roehr, C. C., Reibel, S., Ziegert, M., Sommerfeld, C., Wahn, U., & Niggemann, B. (2001). Atopy patch tests, together with determination of specific IgE levels, reduce the need for oral food challenges in children with atopic dermatitis. The Journal of Allergy and Clinical Immunology, 107(3), pp. 548-53.
Roehr CC, et al. 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(3):548-53. PubMed PMID: 11240959.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Atopy patch tests, together with determination of specific IgE levels, reduce the need for oral food challenges in children with atopic dermatitis. AU - Roehr,C C, AU - Reibel,S, AU - Ziegert,M, AU - Sommerfeld,C, AU - Wahn,U, AU - Niggemann,B, PY - 2001/3/10/pubmed PY - 2001/5/1/medline PY - 2001/3/10/entrez SP - 548 EP - 53 JF - The Journal of allergy and clinical immunology JO - J. Allergy Clin. Immunol. VL - 107 IS - 3 N2 - BACKGROUND: Atopic dermatitis is commonly associated with food allergy. In addition to skin prick tests (SPTs) and measurements of specific IgE levels, the atopy patch test (APT) has recently been introduced into the diagnostic procedure for food allergy. OBJECTIVE: Our aim was to evaluate whether a combination of allergologic tests could improve the prognostic value of the individual tests for positive food challenge results. We hypothesized that the combination of a positive APT result plus proof of specific IgE, a positive SPT result, or both would render double-blind, placebo-controlled, food challenges unnecessary. METHODS: One hundred seventy-three double-blind, placebo-controlled, food challenges were performed in 98 children (median age, 13 months) with atopic dermatitis. All children were subjected to SPTs, APTs, and determination of specific IgE. Sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS: Ninety-five (55%) of 173 oral provocations were assessed as positive. For evaluating suspected cow's milk (CM) allergy, the APT was the best single predictive test (positive predictive value [PPV], 95%), and the combination of a positive APT result with evidence of specific IgE or an APT result together with a positive skin prick test response optimized the PPV to 100%. For hen's egg (HE) allergy, the APT was also the best single predictive test (PPV, 94%). The combination of 2 or more tests did not exceed the APT's predictive value. In both CM and HE challenges, the predictability of oral challenges depended on the level of specific IgE. For wheat allergy, the APT proved to be the most reliable test, and the PPV of 94% could not be improved by a combination with other allergologic tests. CONCLUSION: The combination of positive APT results and measurement of levels of specific IgE (CM, > or = 0.35 kU/L; HE, > or = 17.5 kU/L) makes double-blind, placebo-controlled, food challenges superfluous for suspected CM and HE allergy. SN - 0091-6749 UR - https://www.unboundmedicine.com/medline/citation/11240959/Atopy_patch_tests_together_with_determination_of_specific_IgE_levels_reduce_the_need_for_oral_food_challenges_in_children_with_atopic_dermatitis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-6749(01)50548-5 DB - PRIME DP - Unbound Medicine ER -