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Evaluation of the utility of atopy patch testing, skin prick testing, and total and specific IgE assays in the diagnosis of cow's milk allergy.
Ann Allergy Asthma Immunol 2005; 94(5):553-60AA

Abstract

BACKGROUND

Information on the utility of atopy patch testing (APT) in the diagnosis of food allergy is derived from studies of children with atopic dermatitis.

OBJECTIVE

To evaluate the usefulness of APT in the diagnosis of cow's milk allergy (CMA) and to determine interleukin 4 and interferon-gamma production by peripheral blood mononuclear cells.

METHODS

Thirty-seven children (median age, 11 months) with suspected CMA who had a variety of symptoms that involved many organ systems were evaluated using double-blind placebo-controlled food challenges (DBPCFCs), and the performances of milk specific IgE, skin prick testing (SPT), and APT were determined. To search for a possible relationship between the diagnostic tests and the TH1/TH2 immune response, we measured interferon-gamma and interleukin 4 levels in the supernatants of peripheral blood mononuclear cell cultures.

RESULTS

Seventeen children with positive DBPCFC results and 6 with a history of anaphylaxis were diagnosed as having CMA. The combined use of APT and SPT had a sensitivity of 100% and a negative predictive value of 100% but a specificity of 50% and a positive predictive value of 76%. The addition of milk specific IgE assays to APT and SPT did not improve these values. Pattern of cytokine secretion was not associated with APT positivity or a specific response to DBPCFC.

CONCLUSIONS

Atopy patch testing may be a useful adjunct to SPT in excluding CMA in children who have allergic manifestations other than atopic dermatitis. However, DBPCFCs are still necessary in the presence of positive test results.

Authors+Show Affiliations

Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine and Ihsan Dogramaci Children's Hospital, Hacettepe, Ankara, Turkey.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15945559

Citation

Keskin, Ozlem, et al. "Evaluation of the Utility of Atopy Patch Testing, Skin Prick Testing, and Total and Specific IgE Assays in the Diagnosis of Cow's Milk Allergy." Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology, vol. 94, no. 5, 2005, pp. 553-60.
Keskin O, Tuncer A, Adalioglu G, et al. Evaluation of the utility of atopy patch testing, skin prick testing, and total and specific IgE assays in the diagnosis of cow's milk allergy. Ann Allergy Asthma Immunol. 2005;94(5):553-60.
Keskin, O., Tuncer, A., Adalioglu, G., Sekerel, B. E., Sackesen, C., & Kalayci, O. (2005). Evaluation of the utility of atopy patch testing, skin prick testing, and total and specific IgE assays in the diagnosis of cow's milk allergy. Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology, 94(5), pp. 553-60.
Keskin O, et al. Evaluation of the Utility of Atopy Patch Testing, Skin Prick Testing, and Total and Specific IgE Assays in the Diagnosis of Cow's Milk Allergy. Ann Allergy Asthma Immunol. 2005;94(5):553-60. PubMed PMID: 15945559.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of the utility of atopy patch testing, skin prick testing, and total and specific IgE assays in the diagnosis of cow's milk allergy. AU - Keskin,Ozlem, AU - Tuncer,Ayfer, AU - Adalioglu,Gonul, AU - Sekerel,Bulent E, AU - Sackesen,Cansin, AU - Kalayci,Omer, PY - 2005/6/11/pubmed PY - 2005/7/13/medline PY - 2005/6/11/entrez SP - 553 EP - 60 JF - Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology JO - Ann. Allergy Asthma Immunol. VL - 94 IS - 5 N2 - BACKGROUND: Information on the utility of atopy patch testing (APT) in the diagnosis of food allergy is derived from studies of children with atopic dermatitis. OBJECTIVE: To evaluate the usefulness of APT in the diagnosis of cow's milk allergy (CMA) and to determine interleukin 4 and interferon-gamma production by peripheral blood mononuclear cells. METHODS: Thirty-seven children (median age, 11 months) with suspected CMA who had a variety of symptoms that involved many organ systems were evaluated using double-blind placebo-controlled food challenges (DBPCFCs), and the performances of milk specific IgE, skin prick testing (SPT), and APT were determined. To search for a possible relationship between the diagnostic tests and the TH1/TH2 immune response, we measured interferon-gamma and interleukin 4 levels in the supernatants of peripheral blood mononuclear cell cultures. RESULTS: Seventeen children with positive DBPCFC results and 6 with a history of anaphylaxis were diagnosed as having CMA. The combined use of APT and SPT had a sensitivity of 100% and a negative predictive value of 100% but a specificity of 50% and a positive predictive value of 76%. The addition of milk specific IgE assays to APT and SPT did not improve these values. Pattern of cytokine secretion was not associated with APT positivity or a specific response to DBPCFC. CONCLUSIONS: Atopy patch testing may be a useful adjunct to SPT in excluding CMA in children who have allergic manifestations other than atopic dermatitis. However, DBPCFCs are still necessary in the presence of positive test results. SN - 1081-1206 UR - https://www.unboundmedicine.com/medline/citation/15945559/Evaluation_of_the_utility_of_atopy_patch_testing_skin_prick_testing_and_total_and_specific_IgE_assays_in_the_diagnosis_of_cow's_milk_allergy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1081-1206(10)61133-7 DB - PRIME DP - Unbound Medicine ER -