Atopy Patch Test Research Articles

IL-17 in atopic eczema: Linking allergen-specific adaptive and microbial-triggered innate immune response

Patients with atopic eczema (AE) regularly experience colonization with Staphylococcus aureus that is directly correlated with the severity of eczema. Recent studies show that an impaired IL-17 immune response results in diseases associated with chronic skin infections. We sought to elucidate the effect of IL-17 on antimicrobial immune responses in AE skin. T cells infiltrating atopy patch test (APT) reactions were characterized for IL-17 secretion to varying stimuli. IL-17-dependent induction of the antimicrobial peptide human beta-defensin 2 (HBD-2) in keratinocytes was investigated. Approximately 10% of APT-infiltrating T cells secreted IL-17 after phorbol 12-myristate 13-acetate (PMA)/ionomycin stimulation. Among these, 33% belonged to the newly characterized subtype T(H)2/IL-17. Despite the capacity to secrete IL-17, specific T-cell clones released only low amounts of IL-17 on cognate allergen stimulation, whereas IL-4, IFN-gamma, or both were efficiently induced. IL-17 secretion was not enhanced by IL-23, IL-1 beta, or IL-6 but was enhanced by the S aureus-derived superantigen staphylococcal enterotoxin B. Both healthy and AE keratinocytes upregulated HBD-2 in response to IL-17, but coexpressed IL-4/IL-13 partially inhibited this effect. In vivo, additional application of staphylococcal enterotoxin B induced IL-17 in APT reactions, whereas IL-4, IFN-gamma, and IL-10 were marginally regulated. Induced IL-17 upregulated HBD-2 in human keratinocytes in vivo. IL-17-capable T cells, in particular T(H)2/IL-17 cells, infiltrate acute AE reactions. Although IL-17 secretion by specific T cells is tightly regulated, it can be triggered by bacteria-derived superantigens. The ineffective IL-17-dependent upregulation of HBD-2 in patients with AE is due to a partial inhibition by the type 2 microenvironment, which could partially explain why patients with AE do not clear S aureus.

Atopic dermatitis: Therapeutic concepts evolving from new pathophysiologic insights

Recent insights into the relevance of the epidermal barrier function and its interaction with components of the innate and adaptive immune responses in patients with atopic dermatitis (AD) give rise to a number of novel potential treatment options. In particular, the identification of loss-of-function mutations in the barrier protein filaggrin and of a diminished expression of certain antimicrobial peptides in AD skin stimulates new concepts to think beyond the T(H)1/T(H)2 paradigm. This review will focus on these most recent discoveries and will discuss new and corresponding proof-of-concept trials in patients with AD. It will further speculate on novel ways to restore the homeostasis among the 3 major components in AD skin suspected to be clinically relevant.

Pediatric Eosinophilic Esophagitis: Epidemiology, Diagnosis and Treatment

Eosinophilic esophagitis (EoE) is a disease based on a clinico-pathologic diagnosis which involves a localized eosinophilic inflammation of the esophagus. There has been a significant increase in the incidence of diagnosis of pediatric EoE over the past 10 years due, in part, to a greater recognition of the disease among gastroenterologists, allergists and pathologists. EoE is defined by the presence of 15 or more eosinophils per high-powered field on esophagastroduodenoscopic biopsies isolated to the esophagus associated with characteristic clinical symptoms which do not respond to gastric acid-blockade. While the exact mechanism of EoE is unknown, food allergens are thought to play a significant role. When available, a combination of skin prick and atopy patch testing may be useful when attempting to identify IgE and non-IgE based food allergens in patients with EoE. Effective treatment options include dietary restrictions and various steroid formulations. A multidisciplinary approach is essential for a timely diagnosis and successful treatment strategies in patients with EoE. Keywords: Eosinophilic esophagitis, EoE

Pollen Grains Induce a Rapid and Biphasic Eczematous Immune Response in Atopic Eczema Patients

Eyerich K, Huss-Marp J, Darsow U, et al. Int Arch Allergy Immunol. 2008;145(3):213–223 PURPOSE OF THE STUDY. To investigate the relationship between eczematous reactions in subjects with immunoglobulin E–mediated allergy to pollen grains. STUDY POPULATION. Two populations were evaluated: one population included subjects with atopic eczema who were sensitized to grass or birch pollen and who had a positive atopy patch test, and the second population included subjects without atopic eczema or atopy but who had a positive atopy patch test to nickel. In addition, as control populations, healthy volunteers and atopic subjects with eczema and sensitization to grass or birch but without a positive atopy patch test were included. METHODS. Atopy patch tests with native pollen grains were performed to delineate the effect of native pollen grains on human skin of healthy and atopic individuals. A nickel patch test served as an established model of contact dermatitis. Skin-site samples were taken for biopsy 6 to 96 hours after allergen application and investigated immunohistochemically. RESULTS. Histology of positive patch tests showed an influx of mononuclear cells (predominantly CD4+, CD25+, and CD45RO+). This influx was detected earlier in the pollen patch-test reactions compared with the immune response to nickel. A biphasic cytokine response could be detected in skin samples from the pollen patch test: interleukin 5 dominated in the early phase, and interferon γ dominated in the late phase. The nickel patch test was continuously dominated by interferon γ. CONCLUSIONS. Pollen grains induce eczematous reactions in susceptible individuals. This reaction seems clinically and immunohistochemically similar to the contact hypersensitivity reaction to nickel but follows a faster kinetic and a biphasic course: T-helper 2 and immunoglobulin E in the early (24-hour) phase and T-helper 1 predominance in the late (96-hour) phase. REVIEWER COMMENTS. This article highlights the importance of understanding that type 1 allergy-inducing antigens such as pollens can exacerbate atopic eczema in susceptible individuals. Physicians should remember to discuss this with their atopic patients before the start of pollen season.

Epidemiology of atopy patch tests with food and inhalant allergens in an unselected population of children

Atopy patch test (APT) has been used as a diagnostic tool in patients with suspected food or inhalant allergy. This study assessed the prevalence of positive APT with food or inhalant allergens in an unselected population of schoolchildren. We also evaluated the link between positive APT reactions and skin-prick tests (SPT) for food and inhalant allergens, circulating eosinophils and histamine skin reactivity. We studied an unselected population of 380 children aged 9 or 13 yr living in Rome, Italy. APTs were carried out with food (native or standardized) and inhalant allergens. All the children also underwent skin-prick testing with five common inhalant and four food allergens. We also measured eosinophil cell counts and histamine skin reactivity. The prevalence of positive APT reactions for foods in unselected children ranged between 4% and 11% for hen's egg, tomato, and wheat flour and was similar for both age groups studied. The prevalence of positive APT for milk was significantly lower in children aged 13 than in children aged 9 (p = 0.013). No concordance emerged between positive APT and SPT for foods. Conversely, APT and SPT for inhalant allergens yielded statistically significant concordance (p < 0.001). APT produces positive reactions for food or inhalant allergens in a significant number of subjects in the general population of schoolchildren. Age influences the prevalence of positive APTs with cow's milk to some extent. Inhalant allergens probably induce a positive APT reaction through an immunoglobulin E-linked process, while food allergens probably do not.

Contact and aeroallergens in adulthood atopic dermatitis

Atopic dermatitis (AD) is a clinically well-defined, chronic-intermittant, genetically predisposed skin disease. The increasing number of adult cases observed in the last years has turned the attention to ascertaining factors eliciting skin symptoms. Studies have revealed numerous environmental components (e.g. contact and aeroallergens) that may play an important role in sustaining the symptoms. The aim of the study was to search for contact allergens and aeroallergens triggering the skin disease in adult AD patients. Patients over 18 years from our Atopy Outpatient Department were included in the study. Diagnosis of AD was based on the clinical criteria of Hanifin and Rajka. The distribution of skin symptoms was characteristic for adult AD: hands, shoulders, neck, flexures, face and eyelids. The extremities and the trunk were less involved. The potentially provoking contact and aeroallergens were examined in symptom and drug-free period with atopy patch and epicutaneous tests (APT, ET), which were supplemented by in vitro allergy and Prick tests. The relevance of sensibilization was evaluated by the comparison of in vivo and in vitro test results, medical history and skin symptoms. A total number of 34 cases of adult AD (23 women and 11 men) were studied. Four of them were classified into the intrinsic group (IG; 12%), and 30 were classified into the extrinsic group (EG; 88%). The incidence of contact sensitization to environmental allergens was remarkable: 13 of the EG, 1 of the IG (14 of 34, 41%). In the IG, a late thiomersal positivity was detected without clinical relevance. In the EG, epicutaneous standard series late positivity was seen in 13 patients, in four of them with multiple sensitivity. The allergens causing positivity were nickel (6 of 13), thiomersal (3 of 13), mercury-amidochlorate (3 of 13), mercury-chloride (2 of 13), iodine chlorhyrdoxyquin (1 of 13), lanalcolum (1 of 13) and fragrance mix (1 of 13). Among the detected allergens, the following were relevant: lanalcolum (1 of 13: cosmetics), fragrance mix (1 of 13: cosmetics), nickel (1 of 13: metal objects), thiomersal (1 of 13: eyedrops). No immediate response was seen with APT. Relevant late positivity was shown with APT test in one patient in the IG (1 of 4) to Dermatophagoides pteronyssinus. We observed late positivity in 18 patients in the EG (18 of 30). Among the detected allergens, the following were clinically relevant: D. pteronyssinus and/or Dermatophagoides farinae (15 of 18), cat epithel (4 of 18), timothy pollen (1 of 18) and dog epithel (1 of 18). Furthermore, we examined the relevance of APT, specific immunoglobulin E (IgE) tests and Prick tests. We observed multiplex positivity by specific IgE tests, APT and Prick tests in 14 patients in EG. Sensitization to D. pteronyssinus and/or D. farinae (11 of 14) cat epithel (4 of 14), dog epithel (1 of 14) and timothy pollen (1 of 14) proved to be clinically relevant with the atopic skin symptoms and medical history. The proportion of contact sensitization to environmental allergens in the 34 adult atopic patients was remarkable (14 of 34, 41%). Out of the verified contact allergens, nickel, fragrance mix, thiomersal and lanalcolum proved to be relevant. House dust mite and cat epithel proved to be the most common relevant aeroallergens. D. pteronyssinus and D. farinae sensibilization was high, particularly in patients with severe skin symptoms on the face, eyelids and hands. Pollens should be considered in patients with seasonal relapse of AD. Sensitization to animal epithel was usually indicated by the flare-up of skin symptoms upon contact with animals. The relevance of the eliciting effects of sensitization could easily be supported in most cases by the medical history and the distribution of skin symptoms. In some adult AD patients with long-lasting AD, the relevance of triggering factors is hard to determine.

Proposal for a standardized interpretation of the atopy patch test in children with gastrointastinal symptoms and suspected food allergy

Proposal for a standardized interpretation of the atopy patch test in children with gastrointastinal symptoms and suspected food allergy

Relationship between the atopy patch test and clinical expression of the disease in children with atopic eczema/dermatitis syndrome and respiratory symptoms

The atopy patch test (APT) may be the only positive skin test result in patients with either atopic eczema/ dermatitis syndrome (AEDS) or respiratory abnormalities with or without AEDS. To investigate the possible significance of APT to dust mite by comparing the positive result to this test with that of the skin prick test (SPT) in patients with different characteristics. A total of 297 individuals (178 boys and 119 girls) aged 5 to 221 months (mean [SD] age, 64.5 [42.1] months; median age, 58 months) were included in this study. Participants were divided into 4 groups: current AEDS, current AEDS and respiratory symptoms, past AEDS and respiratory symptoms, and respiratory symptoms with neither current nor past AEDS (control group). All the patients underwent SPT and APT using house dust mite extract. In the study groups, the rate of positivity was significantly higher for APT, whereas in the control group, there were significantly more positive results to SPT (P < .001 for both). Multivariate analysis showed that there was a high probability of a positive APT result in patients with AEDS (odds ratio [OR], 17.4), with AEDS and respiratory disease (OR, 21.9), and with past AEDS and respiratory disease (OR, 22.8). These patients with AEDS showed 2 different patterns of allergic response to allergens, one IgE mediated (as evaluated by positive SPT results) and the other cell mediated (as evaluated by positive APT results). The former seems to follow the so-called atopic march model, and the latter persists even after the disappearance of AEDS and is likely to be implicated in the pathogenesis of respiratory allergy.

Atopy patch tests with aeroallergens in children aged 0–3 years with atopic dermatitis

AllergyVolume 63, Issue 8 p. 1088-1090 Atopy patch tests with aeroallergens in children aged 0–3 years with atopic dermatitis A. C. A. Devillers, Corresponding Author A. C. A. Devillers *DermatologistMedical Center Rijnmond-ZuidGroene Hilledijk 3153075 EA Rotterdamthe NetherlandsTel.: +31 (0)10 290 3960Fax: +31 (0)10 463 6707E-mail: [email protected]Search for more papers by this authorF. B. De Waard-van der Spek, F. B. De Waard-van der SpekSearch for more papers by this authorP. G. H. Mulder, P. G. H. MulderSearch for more papers by this authorA. P. Oranje, A. P. OranjeSearch for more papers by this author A. C. A. Devillers, Corresponding Author A. C. A. Devillers *DermatologistMedical Center Rijnmond-ZuidGroene Hilledijk 3153075 EA Rotterdamthe NetherlandsTel.: +31 (0)10 290 3960Fax: +31 (0)10 463 6707E-mail: [email protected]Search for more papers by this authorF. B. De Waard-van der Spek, F. B. De Waard-van der SpekSearch for more papers by this authorP. G. H. Mulder, P. G. H. MulderSearch for more papers by this authorA. P. Oranje, A. P. OranjeSearch for more papers by this author First published: 08 July 2008 https://doi.org/10.1111/j.1398-9995.2008.01746.xCitations: 3 The atopy patch test: delayed and immediate type reactions in children Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume63, Issue8August 2008Pages 1088-1090 RelatedInformation

Side Effects of Food Atopy Patch Tests

A topy patch test (APT) has recently left experimental grounds and is increasingly used as a standard diagnostic tool for characterizing patients with aeroallergen-triggered disorders and food-triggered disorders (especially atopic dermatitis). There are only a few reports on the side effects of APT, and no results are available for the potential sensitizing risk of this test. According to the position paper of European Academy of Allergology and Clinical Immunology, aluminium cups of 12-mm diameter placed on hypoallergenic tape are recommended. 1 There are no reports on the suitability of alternative materials such as rectangular plastic cups.

Different growth factor requirements for human Th2 cells may reflect in vivo induced anergy.

We previously reported the isolation of allergen-specific Th2 lines and clones from atopy patch test (APT) sites of atopic dermatitis (AD) patients. Upon stimulation with allergen or anti-CD3+ phorbol myristate acetate (PMA) IL-4 was released with or without IL-5, while no (or extremely low concentrations of) IL-2 and interferon-gamma (IFN-gamma) were detectable. A high IL-4/IFN-gamma ratio facilitates production of allergen-specific IgE, of which high levels are observed in AD patients. Here we show that the above mentioned Th2 cells are notably different from murine Th2 cells. Not IL-4, which is the autocrine acting growth factor for murine Th2 cells, but IL-2 was needed for proliferation of these human APT-derived Th2 lines and clones. Of significance, unless exogenous IL-2 was added, no proliferative response to allergen, presented by Epstein-Barr virus-transformed B (EBV-B) cells, non-T cells or IgE-bearing Langerhans cells (LC), occurred. Lack of proliferation and IL-2 production after full T cell receptor (TCR) triggering is a characteristic first described for in vitro anergized T cells. However, like the clones we describe in this study, anergic T cells may retain production of cytokines other than IL-2. A further resemblance between anergic T cells and the human Th2 clones reported here is that IL-4 can enhance IL-2-driven proliferation, but is not capable of inducing T cell growth by itself. The absence of IL-4-driven proliferation differentiates human Th2 cells from murine Th2 cells. Both produce IL-4 when stimulated in a cognate fashion, but only murine Th2 cells will proliferate. We conclude that the presently reported human Th2 cells are different from murine Th2 cells, in that they need other T cells to produce IL-2 required for their expansion. Moreover, the Th2 cells phenotypically resemble anergic T cells. As yet, however, we have no clue as to whether these features account for the current Th2 cells only or for human Th2 cells in general. We hypothesize that the Th2 phenotype of AD skin-derived, allergen-specific T cells may be induced in vivo by LC, which lack CD80, and therefore do not provide secondary signals through CD28-CD80 interaction.

Age-Related Differences in Sensitivity of Peripheral Blood Monocytes to Lipopolysaccharide and Staphylococcus Aureus Toxin B in Atopic Dermatitis

As shown by atopy patch tests, atopic dermatitis (AD) is dominated in its acute phase by the development of a specific T(H)2 response after exposure of the skin to common environmental antigens. Relying on our previous data showing that Staphylococcus aureus enterotoxin B (SEB) induced the activation of monocyte-derived dendritic cells (DCs) through Toll-like receptor (TLR)2 and that SEB-pulsed DCs commit allogenic naive T cells into T(H)2, we assessed monocytes sensitivity to SEB and lipopolysaccharide (LPS) in a group of children and adult patients with AD. Monocytes from AD patients (15 adults with mostly severe disease and 15 children with mild to moderate disease) exhibited an activated and tolerant state as supported by (i) secretion of large amounts of IL-6, IL-10, and tumor necrosis factor-alpha even in the absence of stimulation; (ii) their inability to modulate neither HLA-DR and CD54 nor TLR2 and TLR4 expression after in vitro challenge with SEB; (iii) inhibition of IL-12p70 secretion in response to LPS. Interestingly, monocytes from some of the children studied responded to in vitro challenge with LPS, suggesting new hypotheses to explain disease regression. Our data support the notion that monitoring sensitivity of monocytes to bacterial toxins could prove useful to assess disease progression and prognosis in AD.

The Evaluation of Skin Prick and Atopic Patch Tests with Food and Aeroallergens in Children with Atopic Dermatitis

Atopic dermatitis (AD) affects children with a wide degree of severity. Allergen exposure plays an important role in AD. Immunologic mechanisms in etiology of AD show significant differences from other allergic diseases. We evaluated the skin prick (SPT) and atopy patch test (APT) positivity rates with food-aeroallergens and studied the effect of test results on the clinical characteristics of children with AD. Forty-five children aged 2-15 years with AD were included the study between May 2006-2007 in GATA Haydarpasa Teaching Hospital, Allergy Department. The reactivity to inhalant and food allergens using SPT and APT were evaluated. The severity of AD which was assessed with SCORAD, was compared with aeroallergen and food hypersensitivity. SPT were positive in 68.9% of patients with aeroallergens and 32.5% of patients with food. The APT was positive in 56.8% of patients with food allergens and 47.7% of patients with HDM. Among food, there is only statistical relationship between SPT and APT positivity with wheat flour. There was correlation between only strong(+) reactions to SPT and APT with HDM. There were no effect of food hypersensitivity on the parameters defining disease severity, only the subjective symptoms and SCORAD were significantly higher among the patients with strong SPT(+) reactions to HDM antigens. The statistical significance were only shown between the extent of the disease and strong APT(+) reactions to Dermatophagoides pteronyssinus. It was observed that mainly HDM hypersensitivity was related with disease severity. The statistical significance between APT with food and APT with HDM was considered to be nonspecific reaction of food.

Epicutaneous aeroallergen sensitization in atopic dermatitis infants – determining the role of epidermal barrier impairment

Sensitization to atopens is an early phenomenon that overlaps with the onset of atopic dermatitis (AD) in infancy. Early epidermal barrier impairment may facilitate the epicutaneous penetration of atopens. To correlate transepidermal water loss (TEWL) and aeroallergen sensitization in infants with AD. In this cross-sectional study we enrolled 59 AD children and 30 controls aged 3-12 months. Transepidermal water loss in uninvolved skin, specific immunoglobulin E, atopy patch test (APT) and skin prick tests were performed with respect to seven aeroallergens, i.e., Dermatophagoides pteronyssinus, D. farinae, cat, dog, birch pollen, ambrosia, and cockroach. Environmental conditions were assessed by a questionnaire, and the house dust mite (HDM) concentration was determined in dust samples. Eighty-nine percent of AD infants had a positive APT vs one out of eleven controls. AD infants had a significantly higher mean TEWL than controls (27.4 vs 11.1 g/m(2)/h, P < 0001). Children with two or more positive APT had higher TEWL than the others (31.1 vs 19.0 g/m(2)/h, P < 0.025). No correlation was found between indoor APT results and exposure to HDM, cats, and dogs at home. This study confirms the high prevalence of delayed sensitization to indoor and outdoor aeroallergens in AD infants, and shows that the higher the TEWL, the higher the prevalence of sensitization to aeroallergens. These data are in favor of a major role of a constitutive epidermal barrier impairment in determining early atopen sensitization in infants with AD.

Atopic patch testing

Atopic dermatitis is a major problem among the urban population and it can be aggravated or triggered by various allergens. Atopic patch test can be used as a diagnostic tool in characterizing patients with allergen triggered atopic dermatitis. 1. Patch testing to reproduce an eczematous reaction by applying prick test allergens under occlusion on intact skin. 2. To find the allergen associated with atopic dermatitis. 3. To find the specific allergen which causes or exacerbates atopic dermatitis in a given subject. Seventy five subjects with atopic dermatitis were included in our study and patch tests using prick test allergens were applied to the back. Reading was done after 48 and 72 hours Out of the 75 subjects tested, 47% showed positive reactions, parthenium accounted for 42% of all positive reactions. Epicutaneous application of prick test antigen on intact skin can produce a reaction. Parthenium is commonest allergen in Bangalore. Counselling based on patch test reports may help to reduce morbidity and improve quality of life.

The Atopy Patch Test in the Diagnostic Workup of Suspected Food-Related Symptoms in Children

Mehl A, Rolinck-Werninghaus C, Staden U, et al. J Allergy Clin Immunol. 2006;118:923–929 PURPOSE OF THE STUDY. To determine the utility of atopy patch tests (APTs) in the diagnostic evaluation of food allergy. STUDY POPULATION. A cohort of 437 children (median age: 13 months; 90% with atopic dermatitis) who were referred for evaluation of suspected food allergy. METHODS. Specific serum immunoglobulin E (sIgE) measurements, skin-prick tests (SPTs), APTs, and controlled oral food challenges were performed. RESULTS. The outcomes of 873 oral challenges with cow's milk, hen's egg, wheat, and/or soy were analyzed. 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. By including the APT in the evaluation, only between 0.5% and 7.0% (99% predicted probability) and between 6% and 14% (using 95% predicted probability) of children would fulfill the criteria for avoiding an oral food challenge. CONCLUSIONS. 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 14.0% of study patients. In addition, the APT is time-consuming and demands a highly experienced test evaluator. 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 children with atopic dermatitis. REVIEWER COMMENTS. The APT is presumed to reflect late-phase clinical reactions. However, even with late onset of symptoms (&amp;gt;2 hours after food ingestion), the performance of the APT was not consistent in the children with atopic dermatitis. The question that remains unanswered is whether the APT could be used to diagnose non–IgE-mediated gastrointestinal reactions to foods, such as allergic eosinophilic esophagitis/gastroenteritis or food protein–induced enterocolitis syndrome.

Atopy Patch Test for the Diagnosis of Food Protein-Induced Enterocolitis Syndrome

Fogg MI, Brown-Whitehorn TA, Pawlowski NA, Spergel JM. Pediatr Allergy Immunol. 2006;17:351–355 PURPOSE OF THE STUDY. This prospective study was undertaken to determine if the atopy patch test (APT) is able to predict the results of the oral food challenge (OFC) for food protein–induced enterocolitis syndrome (FPIES). The APT involves placement of food in a Finn chamber (metal cap) left on the skin for 48 hours and evaluated for rash in the subsequent days after removal. STUDY POPULATION. Nineteen patients aged 5 to 30 months who had suspected FPIES on the basis of clinical history. METHODS. The infants underwent APT to the suspected foods. After APT was performed, the subjects underwent OFC to determine if FPIES was present. The results of APT and OFC were compared and used to calculate sensitivity and specificity of the APT. RESULTS. APT predicted the results of OFCs in 28 of 33 instances. There were 16 cases of FPIES confirmed by OFCs. In all 16 cases of FPIES, the APT result was positive to the suspected food. However, the APT was positive in 5 instances in which the OFC result was negative. All 12 patients with a negative APT result had a negative OFC result to the suspected food. CONCLUSIONS. APT seems to be a promising diagnostic tool for the diagnosis of FPIES. REVIEWER COMMENTS. FPIES is a non–immunoglobulin E (IgE)-mediated food allergy in which affected infants develop gastrointestinal symptoms hours after ingestion of the offending food. Current allergy skin and serum tests are not useful for diagnosing this disorder, because they test for food-specific IgE levels that are often negative in FPIES. A diagnostic OFC is the gold standard. The role for APT in diagnosing other non–IgE-mediated food hypersensitivities has been investigated. The results of this study suggest that APT may have some utility in guiding the diagnosis and management of FPIES.

Sensitization to five common aero-allergens in children suffering from atopic eczema as examined by atopy patch tests, skin prick-tests and specific IgE

Sensitization to five common aero-allergens in children suffering from atopic eczema as examined by atopy patch tests, skin prick-tests and specific IgE

Ready-to-use HDM atopy patch test (APT) in the diagnosis of sensitization to HDM in children

Ready-to-use HDM atopy patch test (APT) in the diagnosis of sensitization to HDM in children

Cow's milk allergy in premature infants: a ready-to-use cow's milk atopy patch test before starting an amino-acid formula

Cow's milk allergy in premature infants: a ready-to-use cow's milk atopy patch test before starting an amino-acid formula