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Accuracy of skin prick tests in IgE-mediated adverse reactions to bovine proteins.
Ann Allergy Asthma Immunol 2002; 89(6 Suppl 1):26-32AA

Abstract

OBJECTIVES

To review the recent literature on the diagnostic accuracy of skin prick tests (SPTs) in pediatric food allergy, focusing on adverse reactions to milk and beef. To present data about the test performance characteristics of beef extracts used in SPTs among children with atopic dermatitis (AD) reporting immediate hypersensitivity to beef.

DATA SOURCES

MEDLINE search using the following algorithm ["skin prick test" AND "food allergy" OR allergen; 1997-2002; English; all children]. Prospective sensitivity study of SPTs in 34 patients.

STUDY SELECTION

Thirty-four children with AD (median age 2.29 years) were consecutively recruited between 1992 and 2000 because of immediate reactions to beef. On double-blind, placebo-controlled food challenges (entry criterion), 20 of the patients reacted to beef and 14 did not. Cut-off points for skin prick test wheal positivity was selected by receiving-operator characteristic analysis for fresh and commercial beef allergens. Sensitivity and specificity of skin tests and indices of reproducibility were calculated.

RESULTS

In the literature, the positive predictive accuracies of skin prick tests vary between 69 and 100% and the negative predictive accuracies between 20 to 86% for cow's milk. In our series, SPTs with commercial beef extracts were highly diagnostic (100% sensitivity; 10% false positive rate) and SPTs with fresh beef were highly specific (100%), albeit with a false-positive rate of 21.42%.

CONCLUSIONS

From the literature, we conclude that the diagnostic accuracy of SPTs with milk should be reappraised in the workup of cow's milk allergy. Carrying out commercial and fresh food SPTs at the same time substantially reduces costs and diagnostic work. Oral provocation is necessary in 20.68% of children with AD who have immediate symptoms to beef. Greater allergen standardization and streamlining of the workup of cow's milk allergy are desirable future goals.

Authors+Show Affiliations

Department of Child and Maternal Medicine, The Melloni Hospital, Milan, Italy. allerg@tin.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Controlled Clinical Trial
Journal Article
Review

Language

eng

PubMed ID

12487201

Citation

Fiocchi, Alessandro, et al. "Accuracy of Skin Prick Tests in IgE-mediated Adverse Reactions to Bovine Proteins." Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology, vol. 89, no. 6 Suppl 1, 2002, pp. 26-32.
Fiocchi A, Bouygue GR, Restani P, et al. Accuracy of skin prick tests in IgE-mediated adverse reactions to bovine proteins. Ann Allergy Asthma Immunol. 2002;89(6 Suppl 1):26-32.
Fiocchi, A., Bouygue, G. R., Restani, P., Bonvini, G., Startari, R., & Terracciano, L. (2002). Accuracy of skin prick tests in IgE-mediated adverse reactions to bovine proteins. Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology, 89(6 Suppl 1), pp. 26-32.
Fiocchi A, et al. Accuracy of Skin Prick Tests in IgE-mediated Adverse Reactions to Bovine Proteins. Ann Allergy Asthma Immunol. 2002;89(6 Suppl 1):26-32. PubMed PMID: 12487201.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Accuracy of skin prick tests in IgE-mediated adverse reactions to bovine proteins. AU - Fiocchi,Alessandro, AU - Bouygue,Gabriel R, AU - Restani,Patrizia, AU - Bonvini,Giorgio, AU - Startari,Rosario, AU - Terracciano,Luigi, PY - 2002/12/19/pubmed PY - 2003/1/11/medline PY - 2002/12/19/entrez SP - 26 EP - 32 JF - Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology JO - Ann. Allergy Asthma Immunol. VL - 89 IS - 6 Suppl 1 N2 - OBJECTIVES: To review the recent literature on the diagnostic accuracy of skin prick tests (SPTs) in pediatric food allergy, focusing on adverse reactions to milk and beef. To present data about the test performance characteristics of beef extracts used in SPTs among children with atopic dermatitis (AD) reporting immediate hypersensitivity to beef. DATA SOURCES: MEDLINE search using the following algorithm ["skin prick test" AND "food allergy" OR allergen; 1997-2002; English; all children]. Prospective sensitivity study of SPTs in 34 patients. STUDY SELECTION: Thirty-four children with AD (median age 2.29 years) were consecutively recruited between 1992 and 2000 because of immediate reactions to beef. On double-blind, placebo-controlled food challenges (entry criterion), 20 of the patients reacted to beef and 14 did not. Cut-off points for skin prick test wheal positivity was selected by receiving-operator characteristic analysis for fresh and commercial beef allergens. Sensitivity and specificity of skin tests and indices of reproducibility were calculated. RESULTS: In the literature, the positive predictive accuracies of skin prick tests vary between 69 and 100% and the negative predictive accuracies between 20 to 86% for cow's milk. In our series, SPTs with commercial beef extracts were highly diagnostic (100% sensitivity; 10% false positive rate) and SPTs with fresh beef were highly specific (100%), albeit with a false-positive rate of 21.42%. CONCLUSIONS: From the literature, we conclude that the diagnostic accuracy of SPTs with milk should be reappraised in the workup of cow's milk allergy. Carrying out commercial and fresh food SPTs at the same time substantially reduces costs and diagnostic work. Oral provocation is necessary in 20.68% of children with AD who have immediate symptoms to beef. Greater allergen standardization and streamlining of the workup of cow's milk allergy are desirable future goals. SN - 1081-1206 UR - https://www.unboundmedicine.com/medline/citation/12487201/Accuracy_of_skin_prick_tests_in_IgE_mediated_adverse_reactions_to_bovine_proteins_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=12487201.ui DB - PRIME DP - Unbound Medicine ER -