Abstract
In children with concomitant food allergy and atopic dermatitis (AD), uncovering the causative food allergen is more arduous. We evaluated the basophil activation test (BAT) for its diagnostic value in children, including those with AD, for milk or egg allergy. We simultaneously measured serum-specific immunoglobulin E (sIgE) levels and performed BATs for cow’s milk and egg white. We compared their overall diagnostic performance using the area under the receiver operating characteristic curve (AUC) with the Delong method and compared them in children with AD. Analyses were completed for 75 children for milk allergy and for 85 children for egg allergy. The sIgE and percentage of basophils with the expression of CD63 were correlated for both milk (r = 0.384, p < 0.001) and egg (r = 0.557, p < 0.001). The AUC of sIgE (0.701) for milk allergy was significantly increased when combined with the BAT (0.805; p = 0.029). In children with AD, the AUC of the BAT (0.924) for milk allergy was significantly larger than that of sIgE (0.701; p = 0.017). The BAT is a potentially useful diagnostic tool for milk allergy in children when combined with sIgE. Moreover, it may be a surrogate marker for milk allergy in children with AD.
Highlights
The gold standard for the diagnosis of food allergy (FA) is a double-blind, placebo-controlled food challenge [1]
Among the 89 children included in the study, 14 declined milk-specific immunoglobulin E (IgE) measurement, as they had already been drinking milk without any symptoms, and four declined egg-specific IgE measurement for a similar reason
Patients with milk allergy were older than those without milk allergy. specific immunoglobulin E (sIgE) levels and the percentage of basophils with the expression of CD63 were higher in patients with milk allergy than in those without milk allergy
Summary
The gold standard for the diagnosis of food allergy (FA) is a double-blind, placebo-controlled food challenge [1] It is a time-consuming test and poses a risk of causing an acute allergic reaction, which might be potentially severe [1]. Measurements of basophil sensitivity have been correlated with the threshold of reactivity during an OFC, which can provide information about the severity of the allergic reaction and the risk assessment [15]. We sought to evaluate the diagnostic performance of the BAT for milk and egg allergy, which are two of the most commonly observed allergies in children [16,17], and to compare it with the serum-specific IgE (sIgE) test, which is generally used for diagnosing FA. Since the BAT has been suggested to assess the severity of an allergic reaction, we assessed the utility of the BAT for predicting the severity of milk and egg allergy by evaluating anaphylaxis
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