Abstract
Skin prick tests are the first investigation in allergy diagnostics and their use is described in all the guidelines on atopic eczema. However, the clinical usefulness of skin prick tests is the subject of great debate. On the one hand, skin prick tests allow the identification both of individuals at risk for food allergy and of the allergen inducing the eczematous flare. On the other hand, when performed by a non-specific specialist, positive skin prick tests to foods may wrongly lead to prolonged elimination diets, which may induce nutritional deficiencies and perhaps loss of tolerance to the avoided foods. Furthermore, skin prick tests increase health costs. A consensus on this topic has not yet been reached. Considering the diversity of clinical stages in which it occurs, atopic eczema presentation should be the starting point to determine whether or not skin prick tests should be carried out.
Highlights
Childhood atopic eczema (AE) is a common chronic inflammatory skin disease
Some clinicians consider AE to be strongly related to food allergy and perhaps healed by food avoidance [1,2,3], but others substantially deny such a relationship [4], limiting investigations for food allergy to severe cases in infancy who do not respond to treatment [5]
Among the tests used in clinical practice for detecting IgE-mediated sensitivity, skin prick tests (SPTs) are commonly performed as the first step since they are easy to do, cause almost no trauma to the infant or child, are less expensive compared with serum specific IgE antibodies and the results are quickly ready to support the possible diagnosis of IgE-mediatd food allergy [7,8,9]
Summary
Childhood atopic eczema (AE) is a common chronic inflammatory skin disease. Whether food allergens play a pathogenetic role in inducing exacerbations of AE is a longstanding matter of debate. Some cases have been reported in which, after a long period of exclusion diet, children affected by AE had anaphylactic reactions to cow’s milk that had never occurred previously [50,51], suggesting that the diet itself might have favored the loss of immunologic tolerance and the onset of food allergy This implies that, under these circumstances, the reintroduction of the food should be always planned in a hospital setting, despite the inconveniences for children or parents and the costs for the structure. Further studies are necessary to clarify the unmet needs of SPTs to foods in children with atopic eczema, namely the prediction of response to elimination diet in different age group children, the identification of foods which exacerbate AE, the diagnostic accuracy of SPT with fresh foods, extracts or allergen components, and the performance of cost-effectiveness studies.
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