Atopy Patch Test Research Articles

S0450 Clinical, Endoscopic, Histologic Benefit With Use of Comprehensive Atopy Patch Testing in Adults With Eosinophilic Esophagitis

S0450 Clinical, Endoscopic, Histologic Benefit With Use of Comprehensive Atopy Patch Testing in Adults With Eosinophilic Esophagitis

Chinese Expert Consensus on the Diagnosis and Management of Food Allergy in Children With Atopic Dermatitis#

Abstract The diagnosis of food allergy in clinical practice has not been standardized, and food allergy is overdiagnosed in patients with atopic dermatitis (AD). This overdiagnosis of food allergy leads to unnecessary elimination diets that may exert potential adverse effects on the health of children with AD. Unlike classic IgE-mediated food allergy, food allergy in patients with AD may manifest as non-eczematous reactions, isolated eczematous reactions, or a combination of these reactions. The diagnosis of food allergy in children with AD should be made based on a thorough clinical history (detailed allergic history and feeding history), clinical manifestations, and laboratory workup including skin prick testing, serum specific IgE measurement, atopy patch testing, and oral food challenges. Once an underlying food allergy is confirmed in a patient with AD, comprehensive management is generally recommended. Avoidance of the food allergen is the main treatment approach, but there is a need for regular clinical follow-up, including evaluation of the nutritional status and supervision of growth and development. Multidisciplinary cooperation between dermatologists, nutritionists, and pediatricians is required.

Atopy patch test in the diagnosis of food-aggravated atopic dermatitis in adults in tertiary care

Food allergy and atopic dermatitis often co-exist. Symptoms can include IgE mediated reactions with immediate flushing, urticaria and angioedema to delayed T-cell mediated flares of eczema or a combination of both. Existing workup for food allergy in atopic dermatitis is currently based on clinical history, skin prick tests (SPT), or specific Ig E, followed by an elimination diet and/or standardized oral food challenge. The aim of this study is to evaluate the type of food allergy and the value of food atopy patch tests (APT) in the diagnosis of food allergy in adult patients with atopic dermatitis. We recruited 11 adult patients (3 Male, 8 Female) aged 26-47 years with atopic dermatitis (as per Hannifin and Rajka criteria). All patients kept detailed food diaries and symptoms correlation with questionnaires. They also had blood test specific Ig E, SPT and food APT. If positive, they were advised on a food elimination diet. They were followed up with at least 3 clinic visits over a course of 8-16 months. The results of these investigations were then correlated with their symptoms. Seafood including shrimp (n=8/11, 73%), lobster (n=8/11, 73%), crab (n=7/11, 64%), clam (n=6/11, 55%), and oyster (n=5/11, 46%) were the most perceived culpable food allergens based on the food diaries. The type of symptoms reported ranged from pruritus (n=10/11, 91%), wheals (n=5/11, 46%), flushing (n=5/11, 46%) and eczema flares (n=6/11, 55%). The most commonly observed reaction was that of pruritus, typically experienced within 1 hour of ingestion. Positive symptom correlation with elevated food-specific IgE levels were seen with shrimp (n=3/8, 38%), lobster (n= 2/7, 29%) and crab (n=1/7, 15%). Clinical correlation with positive SPTs were seen with oyster (n=1/6, 17%) and crab (n=1/6, 17%). Positive results across all 3 modalities of specific IgE, SPT and APT was noted with shrimp (n=1/8, 13%). Food APTs were negative for the other allergens. All patients reported improvement in their symptoms after trial of food elimination diet. 1 patient sustained an adverse reaction, he developed an angry back after APT. Seafood, in particular crustacean seafood is a common food allergy seen in adult patients in Singapore. In our small pilot study, food atopy patch test is not useful as a tool for diagnosing food allergy in adult patients with atopic dermatitis. We still need to rely on correlation with clinical history, specific Ig E, SPT, elimination diet +/- oral food challenge.

Reliability of atopy patch tests in detecting protein sensitization in atopic dermatitis: a vehicle comparison

Reliability of atopy patch tests in detecting protein sensitization in atopic dermatitis: a vehicle comparison

The role of food atopy patch test in the diagnosis of food allergy in adults with atopic dermatitis

The role of food atopy patch test in the diagnosis of food allergy in adults with atopic dermatitis

Atopy patch test in children with cow's milk and hen's egg allergy: Do clinical symptoms matter?

Introduction and objectivesSince early 2000s, atopy patch test (APT) has been used to determine non-IgE and mixed-type food allergies. Previous studies have reported conflicting results about the diagnostic value of APT in food allergies, due to non-standardized methods.We aimed to determine the diagnostic efficacy of APT compared to open oral food challenge (OFC) in patients diagnosed with cow's milk allergy (CMA) and hen's egg allergy (HEA) manifesting as atopic dermatitis (AD) and gastrointestinal system symptoms. Materials and methodsIn patients with suspected AD and/or gastrointestinal manifestations due to CMA and HEA, the results of OFC, APT, skin prick test (SPT) and specific IgE (sIgE) were reviewed. Specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of sIgE, SPT, APT and SPT+APT were calculated. ResultsIn total 133 patients with suspected CMA (80) and HEA (53) were included in the study.In patients with CMA presenting with gastrointestinal symptoms, APT had sensitivity of 9.1%, specificity of 100%, PPV of 100% and NPV of 48.7%. In atopic dermatitis patients, sensitivity of APT was 71.4%, specificity 90.6%, PPV 62.5% and NPV 93.6%.In patients diagnosed with HEA, the sensitivity, specificity, PPV and NPV values of APT were 72.0%, 78.6%, 47.2% and 75.0%, respectively. In patients diagnosed with HEA presenting with AD, sensitivity of APT was 87.5%, specificity 70.6%, PPV 73.7% and NPV 85.7%. Atopy patch test had lower sensitivity (44.4%) and higher specificity (90.9%) in patients diagnosed with HEA presenting with gastrointestinal symptoms than those presenting with AD. ConclusionOur study showed that APT provided reliable diagnostic accuracy in atopic dermatitis patients. However, APT had low sensitivity in patients with gastrointestinal symptoms.

Atopy Patch Test and doubtful reactions: interpretation according to morphological features revealed with reflectance confocal microscopy

article: Atopy Patch Test and doubtful reactions: interpretation according to morphological features revealed with reflectance confocal microscopy - Giornale Italiano di Dermatologia e Venereologia 2020 Apr 29 - Minerva Medica - Journals

Atopy patch testing with aeroallergens in a large clinical population of dermatitis patients in Germany and Switzerland, 2000-2015: a retrospective multicentre study.

The diagnostic significance of the atopy patch test for the management of dermatitis possibly triggered by aeroallergens is still controversial. However, sufficiently large studies with routinely tested standardized aeroallergen patch test preparations in dermatitis patients are lacking. To evaluate the reaction frequency and the reaction profiles of 10 until mid-2015 commercially available, standardized aeroallergen patch test preparations of the 'Stallerpatch' test series (Stallergenes, Antony Cedex, France) in a large multicentre patient cohort. A retrospective data analysis of patients with suspected aeroallergen-dependent eczematous skin lesions was performed, who were patch tested in 15 Information Network of Departments of Dermatology-associated clinics between 2000 and 2015. Patients were stratified according to their atopic dermatitis (AD) status. The study group included 3676 patients (median age 41years, 34.8% males, 54.5% AD). The most common aeroallergens causing positive patch test reactions were Dermatophagoides pteronyssinus (19.6%), Dermatophagoides farinae (16.9%), birch (6.2%), timothy grass (6.0%), cat dander (5.4%), mugwort (4.9%) and dog dander (4.6%). Reactions to other pollen allergen preparations, that is 5 grasses (3.2%), cocksfoot (2.1%) and plantain (1.6%), were less common. Positive patch test reactions to aeroallergens were consistently more frequent in patients with AD. These patients showed proportionally less dubious, follicular, irritant and weak positive reactions. Independent of AD status, a patient history of past or present allergic rhinitis was associated with an increased chance of a positive aeroallergen patch test reaction to pollen allergens. The aeroallergen patch test is a useful add-on tool in clinical routine, especially in patients with AD and/or respiratory allergy. A patch test series comprising Dermatophagoides pteronyssinus, Dermatophagoides farinae, birch, timothy grass, cat dander and mugwort seems to be suitable. Controlled studies with specific provocation and elimination procedures are required to further evaluate the diagnostic significance of the proposed screening series.

Evaluation of contact sensitivity to food additives in children with atopic dermatitis.

IntroductionAtopic dermatitis (AD) is a chronic inflammatory disease caused by the complex interaction of genetic, immune and environmental factors such as food and airborne allergens. The atopy patch test (APT) is a useful way to determine delayed-type hypersensitivity reactions to food and aeroallergens. Many studies have also suggested that food additives are associated with dermatologic adverse reactions and the aggravation of pre-existing atopic dermatitis symptoms.AimTo elucidate the contact sensitivity to food additives in children suffering from AD by using standardized atopy patch testing.Material and methodsA total of 45 children with AD and 20 healthy children have been enrolled. All the children have regularly consumed food containing additives, and were subjected to atopy patch tests.ResultsIn total, 28 (62%) children with AD and 4 (20%) healthy children have had positive patch test reactions to ≥ 1 allergens. There has been a significant difference (p = 0.04) between the groups in terms of the positivity rate in the patch test and the most common allergen that elicited positive patch test results in the AD group was azorubine (n = 11, 24.4%, p = 0.014).ConclusionsIn our study, contact sensitivity was detected more frequently in AD patients. Food additives may play a role in the development and exacerbation of AD. Atopy patch testing with food additives can be useful in the treatment and follow-up of children with AD.

Can allergy patch tests with food additives help to diagnose the cause in childhood chronic spontaneous urticaria?

IntroductionChronic spontaneous urticaria (CSU) is characterized by the onset of symptoms which are not induced by specific triggers, but are rather spontaneous. A considerable number of patients report that foods or food additives might be responsible for their chronic urticaria.AimTo determine the prevalence of sensitization to food additives in children with CSU using atopy patch tests (ATP).Material and methodsAtopy patch tests for 23 different food additives were applied to 120 children with CSU and 61 healthy controls.ResultsSeventeen (14.1%) children with CSU were sensitized with food additives. None of the control group had positive APT. Azorubine and Cochineal red were the food additives detected with the highest sensitization rates (5.8% (n = 7) and 6.7% (n = 8), respectively).ConclusionsThere can be an association between food additives and CSU. APT tests may be a helpful tool in the assessment and management of CSU so that easier to follow diets and effective treatments can be offered to families.

Atopy patch tests may identify patients at risk for systemic contact dermatitis.

BackgroundA subset of patients with positive patch tests demonstrates systemic contact dermatitis (SCD) upon ingestion or inhalation of the allergen. Concern has been raised about the use of patch tests for protein allergens (APTs) to detect SCD in atopic dermatitis (AD) patients.MethodsWe present atopy patch test (APT) data for 97 people. We reviewed APTs and tests for antigen‐specific immunoglobulin E (IgE) to the same allergen in pediatric AD patients. We compared the frequency of APTs as a function of age in AD patients. To study the irritancy potential of APTs, we prospectively tested consenting non‐AD dermatitis patients undergoing evaluation for allergic contact dermatitis and healthy controls to an APT panel.ResultsAPT demonstrated fewer positive results than serum‐specific IgE or skin prick tests to the same allergen. Positive APT to food was more common in children under 3 years, whereas positive APT to aeroallergens were more common in teens and adults. Only positive APTs to dust mite were significantly more common positive in subjects without AD.ConclusionOur aggregate findings suggest that most APTs, but not dust mite, behave like conventional patch tests to low‐potency allergens. They are more likely to be positive in patients with chronically inflamed skin and to identify allergens that cause SCD. The higher prevalence of APT positivity to foods in young children is consistent with food allergy as a trigger of AD (also known as SCD) being more common in children than adults. Positive APTs define patients who may have SCD; negative APTs may guide elimination diets.

Comparison of Cross Reactions Between Cow’s Milk and Other Mammals’ Milk Using Skin Prick Test and Atopy Patch Test in Children with Atopic Dermatitis and Cow’s Milk Allergy

Objective: The use of other mammals’ milk as an alternative treatment of cow’s milk allergy is controversial due to their similar protein structures. In the present study, we aimed to investigate cross reactions with sheep’s, goat, and camel’s milks using skin prick test and atopy patch test in children with cow’s milk allergy. Materials and Methods: Our study group was composed of patients with atopic dermatitis who were diagnosed with cow’s milk allergy in our former study where we investigated the sensitivity of different diagnostic tests commonly used to determine cow’s milk allergy. In all patients, cow’s milk, sheep’s milk, goat’s milk and camel’s milk were used for skin prick test and atopy patch test. The study data were analyzed with SPSS 20.0 for Windows. Results: Among the patients with cow’s milk allergy, 15 (63%) had early-onset and 9 (37%) late-onset reactions with provocation tests. Seven (70%) of 10 children who were found skin prick test positive with cow’s milk were shown to have a cross reaction against goat’s and sheep’s milk with skin prick test; 8 (88.8%) of 9 children who were found to be atopy patch test positive with cow’s milk had a cross reaction against goat’s milk, and 7 (66.6%) against sheep’s milk. No patient with cow’s milk allergy had a cross reaction with camel’s milk with either skin prick test or atopy patch test. Conclusion: Our study demonstrated that a cross reaction occurs at a quite high rate between cow’s milk, sheep’s milk and goat’s milk as revealed by both skin prick testing and atopy patch test, whereas there was no demonstrable cross reaction between cow’s milk and camel’s milk by either method.

UPDATE ON FOOD ALLERGIES

Food allergy has been defined as adverse reaction to food in which “immunological mechanism have been demonstrated”. The clinical presentation of food allergy involves a large spectrum of symptoms ranging from skin like urticaria, angioedema, atopic eczema, dermatitis, gastrointestinal (vomiting, colic, abdominal pain, diarrhea, constipation), respiratory (rhinorrhea, sneezing, cough, dyspnea). According to a recent review the point prevalence of self-reported food allergy is approximately six times higher than challenge food allergy. A proper diagnosis is necessary for a sufficient and safe management. The core stone of diagnosis of food allergy is a careful dietary history. Mostly food allergies are self reported, but also a great number of tests are available. The most widely used tests for food allergies diagnosis are: skin prick tests (SPT), specific IgE (sIgE), component resolved diagnosis (CRD) and the atopy patch test (APT). Besides food avoidance there is also growing interest in the effectiveness of potential immunomodulatory treatment approaches, including sublingual and oral immunotherapy to induce tolerance, particularly for peanut allergy.

The diagnostic value of APT for food allergy in children: a systematic review and meta‐analysis

The role of atopy patch test (APT) in the diagnosis of food allergy (FA) remains largely controversial. In our meta-analysis, we aimed to evaluate the accuracy of APT for diagnosing FA in children. Pubmed, Embase and Cochrane Library were searched for studies regarding the diagnostic value of APT for FA in children compared to oral food challenge (double-blind placebo-controlled food challenge and/or open food challenge). The last search was conducted on November 11, 2017. Two reviewers independently screened relevant studies and assessed the quality by QUADAS-2. Meta-analysis was performed to calculate the pooled sensitivity, specificity, DOR (diagnostic odds ratio), PLR (positive likelihood ratio), NLR (negative likelihood ratio) with their 95% confidence intervals (CIs). Subgroup analyses were conducted according to different food allergens, atopic dermatitis, gastrointestinal symptoms, and age younger than 3years. Forty-one studies were included in the meta-analysis. The pooled sensitivity, specificity, PLR, NLR and DOR were 50.30% (95% CI 48.40%-52.30%), 86.60% (95% CI 85.30%-87.80%), 3.405 (95% CI 2.594-4.470), 0.545 (95% CI 0.469-0.634) and 7.528 (95% CI 5.507-11.206), respectively. However, for children with FA-related gastrointestinal symptoms, the pooled sensitivity and specificity were 57.40% (95% CI 52.10%-62.50%) and 91.50% (95% CI 88.30%-94.10%) respectively. Our findings suggest that APT is specific but not sensitive for diagnosing FA in children, especially in children with FA-related gastrointestinal symptoms.

ATOPY PATCH TESTING IN PEDIATRIC PATIENTS WITH PROTON PUMP NON-RESPONSIVE EOSINOPHILIC ESOPHAGITIS

Introduction The role of atopy patch testing (APT) in Eosinophilic Esophagitis (EoE) remains controversial with no clear guidance for utility in the Food Allergy Practice Parameters. This exploratory study examines the use of APT in pediatric patients with EoE. Methods A retrospective chart review from 08/2017 to 06/2018 was conducted at a large academic Allergy/Immunology Division. Pediatric patients with a diagnosis of EoE who underwent APT in conjunction with skin prick testing to guide food elimination were identified. Results of APT and response to dietary elimination were evaluated using descriptive statistics. Results 45 patients, ages 2 to 18 years, were identified with initial screening. 5 patients had APT prior to second biopsy showing PPI responsiveness and were excluded. Three patients were lost to follow-up. 1 patient was diagnosed with an eating disorder and did not undergo food elimination. 5 additional patients have follow-up endoscopy pending. A total of 31 patients were included in final assessment: 23 males and 8 females, average age 9 years. Of the 31 patients, 1 had improvement on biopsy that could be uniquely attributed to APT. The remaining 30 patients (97%) had APT that was not useful in identification of triggering foods. Conclusions In our sample of pediatric EoE patients, APT was not useful in identifying foods for removal. Given the productivity loss for both patients and parents as well as the increased financial costs of patch tests and three additional visits, guidelines on EoE management should be adapted to more strongly discourage APT for identification of triggering foods.

Food-Related Contact Dermatitis, Contact Urticaria, and Atopy Patch Test with Food

A wide variety of foods may cause or aggravate skin diseases such as contact dermatitis, contact urticaria, or atopic dermatitis (AD), both in occupational and private settings. The mechanism of action underlying allergic disease to food, food additives, and spices may be immunologic and non-immunologic. The classification and understanding of these reactions is a complex field, and knowledge of the possible reaction patterns and appropriate diagnostic test methods is essential. In addition, certain foods may cause worsening of atopic dermatitis lesions in children. The atopy patch test (APT) is a well-established, clinically useful tool for assessing delayed type reactions to protein allergens in patients and may be useful to detect protein allergens relevant for certain skin diseases. The APT may even detect sensitization against allergens in intrinsic atopic dermatitis patients, who show negative skin prick test and negative in vitro IgE test results against these allergens. Native foods, SPT solutions on filter paper, and purified allergens in petrolatum have been used for APT. The European Task Force on Atopic Dermatitis (ETFAD) has worked on standardizing this test in the context of AD patients, who are allergic to aeroallergens and food. This recommended, standardized technique involves test application at the upper back of children and adults; use of large, 12-mm Finn chambers; avoidance of any pre-treatment such as tape stripping or delipidation; standardized amounts of purified allergens in petrolatum; and use of the standardized ETFAD reading key. The APT may not be the best working or best standardized of all possible skin tests, but it is the best test that we currently have available in this niche.

Patch testing in gastrointestinal diseases – a systematic review of the patch test and atopy patch test

Patch testing in gastrointestinal diseases – a systematic review of the patch test and atopy patch test

Is the Atopy Patch Test Reliable in the Evaluation of Food Allergy-Related Atopic Dermatitis?

Background: Aeroallergens and food allergens are found to be relevant in atopic dermatitis. The atopy patch test (APT) can help to detect food allergies in children with atopic dermatitis. This study evaluates if the APT is a valuable tool in the diagnostic workup of children with food allergy-related atopic dermatitis. Methods: 42 children between 6 months and 12 years of age were selected at the Mofid Children Hospital. Atopic dermatitis was diagnosed, and the severity of the disease was determined. At the test visit, the patients underwent a skin prick test (SPT), APT, and serum IgE level measurement for cow's milk, egg yolk, egg white, wheat, and soy. Results: We found a sensitivity of 91.7%, a specificity of 72.7%, a positive predictive value (PPV) of 88%, a negative predictive value (NPV) of 80%, and an accuracy of 85.7% for APT performed for cow's milk. APT performed for egg yolk had a sensitivity and a NPV of 100%, while the same parameters obtained with egg white were 84.2 and 75%, respectively. The sensitivity, specificity, and NPV of the APT for wheat were 100, 75, and 100%, respectively. The sensitivity, PPV, and NPV of the APT for soy were 87.5, 70, and 87.5%, respectively. Conclusions: Our data demonstrate that the APT is a reliable diagnostic tool to evaluate suspected food allergy-related skin symptoms in childhood and infancy.

Brazilian experience with atopy patch tests for Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis

Background The aim of this study was to evaluate the positivity rates of atopy patch tests for Dermatophagoides pteronyssinus, Dermatophagoides farinae and Blomia tropicalis in patients with respiratory diseases such as asthma and allergic rhinitis with or without atopic dermatitis.Methods The patients’ clinical histories were collected, and the patients were subjected to skin prick and patch tests with the three different house dust mites on the same day. The patch tests were examined 48 hours later, and then patients were divided into two groups: I- patients with respiratory diseases, such as asthma and/or rhinitis, and atopic dermatitis and II-patients with only respiratory diseases. A total of 74 patients ranging in age from 2 to 60 years were included in this study; 16 patients were included in group I and 58 were included in group II. This study was approved by the human ethics committee of the Faculty of Medical Science and Health SUPREMA (number 2.007.135), and written informed consent was collected from each patient or their parents prior to enrollment.Results In the skin prick tests, the most prevalent mite that evoked a reaction was Dermatophagoides pteronyssinus, followed by Dermatophagoides farinae and Blomia tropicalis. Regarding the atopy patch tests, the mite that most frequently induced a positive reaction was Dermatophagoides farinae (78.4%), followed by Dermatophagoides pteronyssinus (77%) and Blomia tropicalis (52.7%). A comparison of the skin prick and atopy patch tests revealed that 53 patients (71.6%) were positive on both tests, and 30 (56.6%) patients were positivite for the same mite. We found six patients (8%) who had a positive clinical history of allergy and only exhibited positivity on the atopy patch test.Discussion Most studies have been performed with atopic dermatitis patients, but in this study, most of the patients had respiratory conditions. Blomia tropicalis is a mite that is prevalent in tropical areas, such as Brazil, and only two publications include these three mites, wich are present in Brazil. The APT may produce positive results in concordance with the SPT resuts, but may also be the only positive test ( 8%) as we observed in our study. These results suggest that the mite atopy patch test is relevant and should be considered as an additional test for patients with clinical histories of allergic respiratory disease who have negative prick test results.Conclusion The APT should be considered as an additional test when the SPT and specific serum IgE tests are negative in patients with clinical histories of allergies.

The Incidence of Delayed-Type Hypersensitivity Reactions to Apples Among Patients Allergic to Birch Pollen.

The major apple allergen Mal d 1 cross-reacts with the homologous birch pollen allergen Bet v 1 and causes immunoglobulin E (IgE)-mediated immediate-type allergic reactions. In some patients, delayed-type hypersensitivity to apples may develop within 72 hours without evidence of specific IgE or a positive skin prick test (SPT). The aim of the study was to evaluate the concomitance of delayed-type hypersensitivity reactions and immediate IgE-mediated reactions against high- and low-allergenic apple cultivars in patients with birch pollen allergy. Data were obtained from 45 adults with clinical symptoms of birch pollen allergy. Patients were exposed to apple pulp via atopy patch tests (APTs) and SPTs. Levels of IgE specific to Bet v 1 and Mal d 1 were measured with a radioallergosorbent test. Patients allergic to birch pollen showed the highest rate of positive SPT responses to Golden Delicious apples and the lowest rate to low-allergenic cultivar Grey French Reinette. Among these patients, 9% developed delayed hypersensitivity reactions to either Golden Delicious or Grey French Reinette apples; these reactions manifested clinically as erythema with papules (class ++). Fifty percent of APT-positive patients were concomitantly SPT-negative. Here, we show for the first time the clinical relevance of T cell-driven allergic reactions to apples. APTs may reveal type IV sensitization in patients who are negative for the corresponding type I sensitization tests. Thus, utilization of the APT procedure with fresh apple appears to be a valuable tool for the diagnosis of apple allergy and may improve the accuracy of food allergy diagnoses.