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The atopy patch test in the diagnostic workup of suspected food-related symptoms in children.
J Allergy Clin Immunol 2006; 118(4):923-9JA

Abstract

BACKGROUND

There is an increasing need to develop test instruments that make oral food challenges superfluous.

OBJECTIVE

We sought to study the utility of atopy patch tests (APTs) in the diagnostic workup of food allergy.

METHODS

We investigated 437 children (median age, 13 months; 90% with atopic dermatitis) referred for evaluation of suspected food allergy. Specific serum IgE (sIgE) measurements, skin prick tests (SPTs), APTs, and controlled oral food challenges were performed.

RESULTS

We analyzed 873 oral challenges with cow's milk, hen's egg, wheat, and/or soy. One thousand seven hundred single APTs were performed. As a single parameter, the APTs showed the best specificity compared with sIgE measurements, SPTs, or both. Combining the APT with either the SPT or sIgE measurement resulted in improved sensitivity and specificity. Decision points for sIgE measurement and for the SPT showed lower values when combined with a positive APT result. Correctly bypassing an oral food challenge with combined testing, including APTs, only between 0.5% and 7% (99% predicted probability) and between 6% and 14% (using 95% predicted probability) of children would fulfill the criteria for avoiding an oral food challenge.

CONCLUSION

Although the predictive capacity of the APT is improved when combined with sIgE measurement or the SPT, oral food challenges become superfluous in only 0.5% to 14% of study patients. In addition, the APT is time consuming and demands a highly experienced test evaluator.

CLINICAL IMPLICATIONS

For daily clinical practice, the APT adds only a small predictive value to the standard SPT and sIgE measurement in the diagnostic workup of suspected food-related symptoms in our study population.

Authors+Show Affiliations

Department of Pediatric Pneumology and Immunology, University Children's Hospital Charité, Berlin, Germany.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17030247

Citation

Mehl, Anne, et al. "The Atopy Patch Test in the Diagnostic Workup of Suspected Food-related Symptoms in Children." The Journal of Allergy and Clinical Immunology, vol. 118, no. 4, 2006, pp. 923-9.
Mehl A, Rolinck-Werninghaus C, Staden U, et al. The atopy patch test in the diagnostic workup of suspected food-related symptoms in children. J Allergy Clin Immunol. 2006;118(4):923-9.
Mehl, A., Rolinck-Werninghaus, C., Staden, U., Verstege, A., Wahn, U., Beyer, K., & Niggemann, B. (2006). The atopy patch test in the diagnostic workup of suspected food-related symptoms in children. The Journal of Allergy and Clinical Immunology, 118(4), pp. 923-9.
Mehl A, et al. The Atopy Patch Test in the Diagnostic Workup of Suspected Food-related Symptoms in Children. J Allergy Clin Immunol. 2006;118(4):923-9. PubMed PMID: 17030247.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The atopy patch test in the diagnostic workup of suspected food-related symptoms in children. AU - Mehl,Anne, AU - Rolinck-Werninghaus,Claudia, AU - Staden,Ute, AU - Verstege,Andrea, AU - Wahn,Ulrich, AU - Beyer,Kirsten, AU - Niggemann,Bodo, Y1 - 2006/08/24/ PY - 2006/03/13/received PY - 2006/07/04/revised PY - 2006/07/05/accepted PY - 2006/10/13/pubmed PY - 2006/12/9/medline PY - 2006/10/13/entrez SP - 923 EP - 9 JF - The Journal of allergy and clinical immunology JO - J. Allergy Clin. Immunol. VL - 118 IS - 4 N2 - BACKGROUND: There is an increasing need to develop test instruments that make oral food challenges superfluous. OBJECTIVE: We sought to study the utility of atopy patch tests (APTs) in the diagnostic workup of food allergy. METHODS: We investigated 437 children (median age, 13 months; 90% with atopic dermatitis) referred for evaluation of suspected food allergy. Specific serum IgE (sIgE) measurements, skin prick tests (SPTs), APTs, and controlled oral food challenges were performed. RESULTS: We analyzed 873 oral challenges with cow's milk, hen's egg, wheat, and/or soy. One thousand seven hundred single APTs were performed. As a single parameter, the APTs showed the best specificity compared with sIgE measurements, SPTs, or both. Combining the APT with either the SPT or sIgE measurement resulted in improved sensitivity and specificity. Decision points for sIgE measurement and for the SPT showed lower values when combined with a positive APT result. Correctly bypassing an oral food challenge with combined testing, including APTs, only between 0.5% and 7% (99% predicted probability) and between 6% and 14% (using 95% predicted probability) of children would fulfill the criteria for avoiding an oral food challenge. CONCLUSION: Although the predictive capacity of the APT is improved when combined with sIgE measurement or the SPT, oral food challenges become superfluous in only 0.5% to 14% of study patients. In addition, the APT is time consuming and demands a highly experienced test evaluator. CLINICAL IMPLICATIONS: For daily clinical practice, the APT adds only a small predictive value to the standard SPT and sIgE measurement in the diagnostic workup of suspected food-related symptoms in our study population. SN - 0091-6749 UR - https://www.unboundmedicine.com/medline/citation/17030247/The_atopy_patch_test_in_the_diagnostic_workup_of_suspected_food_related_symptoms_in_children_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0091-6749(06)01390-X DB - PRIME DP - Unbound Medicine ER -