Predictors of positive food challenge outcome in non–IgE-mediated reactions to food in children with atopic dermatitis

Abstract

Background: Atopic dermatitis is frequently associated with food allergy. In general, clinically manifested food allergy is regarded as IgE mediated. However, there are some children with food allergy for whom IgE hypersensitivity cannot be proven. Objective: The aim was to evaluate the percentage of children with positive double-blind, placebo-controlled food challenge (DBPCFC) results but without any proof of IgE sensitization and to characterize this subgroup of children. Methods: Two hundred eight DBPCFCs were performed in 139 children (median age, 13 months) with atopic dermatitis and suspected food-related clinical symptoms. All children were subjected to skin prick tests (SPTs), determination of specific IgE, and atopy patch tests. Results: One hundred eleven (53%) of 208 oral food challenge results were assessed as positive. Positive challenge results were separated into 2 groups according to IgE positivity: negative SPT and negative specific IgE results in serum (group A, n = 12) and positive SPT, specific IgE, or both results in serum (group B, n = 99). The atopy patch test results; the distribution of early, late, or both clinical reactions; the age of the children; and the total IgE levels all showed no significant differences between the 2 groups. However, wheat challenge results were more often positive among the apparently non–IgE-sensitized children, and hen's egg challenge results were more often positive in the sensitized group (P < .05). Conclusion: Around 10% of positive DBPCFC results are not IgE mediated. Therefore not the proof of specific IgE but the suspicion of food-related symptoms should be the indication to perform oral food challenges, especially in the case of wheat. Otherwise, some children will not receive diagnoses for food allergy and be denied the benefits of a specific diet. (J Allergy Clin Immunol 2001;108:1053-8.)