Atopy Patch Test in the Diagnosis of Food Allergy in Children with Atopic Dermatitis

Miloš Jeseňák,Peter Bánovčin

doi:10.14712/18059694.2017.132

Miloš Jeseňák, Peter Bánovčin

Open Access

https://doi.org/10.14712/18059694.2017.132

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Abstract

Atopic eczema/dermatitis syndrome (AEDS) is one of the most common chronic allergic diseases in children. Among the allergens found to be relevant in AEDS, aeroallergens and food allergens are the most important. The exposure of these patients to their relevant protein allergens can trigger an exacerbation or maintain the disease. AEDS is frequently associated with food allergy, which complicates the management in approximately 40% of these children. Atopy patch test (APT) can help in detecting food allergies in children with AEDS. The earliest publication on patch testing in eczema was described in 1937 by Rostenberg, but the first controlled clinical trial was provided by Mitchell in 1982. APT with food allergens were introduced into clinical use in 1996 by the group of Isolauri. APT test is performed epicutaneously with typical immediate-type allergens (aeroallergens or foods). As a number of apparently minor test modifications greatly influence the sensitivity, specificity, and reproducibility of the APT, the European Task Force on Atopic Dermatitis (ETFAD) has developed a standardized APT technique. APT has developed into a valuable additional tool in the diagnostic work-up of food allergy in infants and children with atopic dermatitis.

Highlights

Among the allergens found to be relevant in Atopic eczema/dermatitis syndrome (AEDS), aeroallergens and food allergens are the most important [4]
Atopy patch test (APT) involves the epicutaneous application of intact protein allergens (1st type of allergen) in a diagnostic patch test setting with an evaluation of the induced eczematous skin lesions after 24 to 72 hours
Reading at 48 hours (20 minutes after removing of the set) and 72 hours Exclusion criteria for APT: – test site free of topical steroids for 7 days – test site without ultraviolet treatment for 4 weeks – patients free of oral steroids, cyclosporine A or tacrolimus – avoidance of antihistamins for 5 days – non-pregnant * Whereas the availability of standardized food allergens is poor and many foods contain more than one protein which can cause allergic reaction, fresh native foods or dried foods dissolved in saline or water can be used for APT [20]

Summary

Introduction

Atopy patch test (APT) seems to be a valuable additional diagnostic tool in the diagnostic work-up of food allergy in children with AEDS, especially with regard to late-positive clinical reactions. APT involves the epicutaneous application of intact protein allergens (1st type of allergen) in a diagnostic patch test setting with an evaluation of the induced eczematous skin lesions after 24 to 72 hours.

Results

Conclusion