Atopy Patch Test Research Articles

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lettersReply Hossein Moravej Hossein Moravej Department of Pediatric, Nemazee Hospital, Shiraz, Iran Search for more papers by this author Email the corresponding author at [email protected] Published Online::1 Dec 2011https://doi.org/10.5144/0256-4947.2011.662SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionI read the letter from Dr. Mahmood Al-Mendalawi and his suggestion about the use of the atopy patch test (APT) rather than skin prick test (SPT) in infantile colic. SPT is a painful method for infants, but certainly it is simpler and less troublesome than dietary changes in infants.In our study, we found that the elimination of cow's milk from mother's diet in exclusively breast-fed infants had no effect on the symptoms of colic in infants with a negative SPT. We did not conclude that performing this test as a routine test for all cases of infantile colic. As mentioned in the article, more studies are needed to determine which patients will benefit from these tests.The atopy patch test is a good test, especially for diagnosis of late-phase clinical reactions, but the SPT is especially useful for diagnosis of immediate-type reactions.1,2 Although in multiple studies, the APT has been introduced as an acceptable method for diagnosis of food allergy, its sensitivity and specificity has been variable.3,4 As Dr. Al-Mendalawi mentioned, the predictive value of APT in infantile colic needs extensive comparative studies.ARTICLE REFERENCES:1. In: Cudowska B, Kaczmarski M. "Atopy patch test in the diagnosis of food allergy in children with atopic eczema dermatitis syndrome" . Rocz Akad Med Bialymst. 2005; 50:261-7. Google Scholar2. In: Chung BY, Kim HO, Park CW, Lee CH. "Diagnostic Usefulness of the Serum-Specific IgE, the Skin Prick Test and the Atopy Patch Test Compared with That of the Oral Food Challenge Test" . Ann Dermatol. 2010; 22:404-411. Google Scholar3. In: Lipozencic J, Wolf R. "The diagnostic value of atopy patch testing and prick testing in atopic dermatitis: facts and controversies" . lin Dermatol. 2010; 28:38-44. Google Scholar4. In: Wainstein BK, Kashef S, Ziegler M, Jelley D, Ziegler JB. "Frequency and significance of immediate contact reactions to peanut in peanut-sensitive children" . Clin Exp Allergy. 2007; 37:839-45. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 31, Issue 6Nov–Dec 2011 Metrics History Published online1 December 2011 InformationCopyright © 2011, Annals of Saudi MedicineThis is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.PDF download

PP77 CELIAC DISEASE'S SOCIAL DAMAGE

gastrointestinal tract is a common finding in pediatric colonoscopies. Its clinical significance and its pathophysiological mechanism are yet unclear, although it was described as being associated with cow’s milk and other food allergies. Aim of this study was to evaluate the clinical course of LNH in a group of children undergone different treatment strategies and to assess the possible association between LNH and food allergy (FA). Methods: We performed a retrospective chart review of 66 consecutive patients (pts) with a diagnosis of LNH (39 male, 27 female, median age 7.5 years). Nineteen pts were treated with a cow’s milk, egg and soy elimination diet (Group A), 16 with mesalamine (Group B), 14 with elimination diet plus mesalamine (Group C), and 17 had no therapy (Group D). Apart from ileocolonoscopy with biopsy, all pts underwent routine biochemistry, skin prick tests and atopy patch test for food allergens. In each patient an accurate family and personal history for atopy was recorded. All pts were followed for at least 4 months. Response to treatment was defined as having no symptoms at the end of the observational period. Results: Indications to colonoscopy were: hematochezia (with or without diarrhea) in 73% of pts, recurrent abdominal pain with chronic diarrhea in 25%, chronic diarrhea in 2%. Forty-five of 66 pts (68%) presented a LNH of the terminal ileum, whereas 21 (32%) had a LNH of terminal ileum and colon. No patient had an isolated LNH of the colon. Allergy tests were positive in 35% of pts, of these 61% had positive skin prick tests, and 35% positive patch tests. Four percent of pts had positive both tests. Eighty, 86, 83 and 79% in group A, B, C, and D, respectively, had a clinical response. No significant differences in the response rates among the 4 groups based on family or personal clinical history of allergy, type and duration of clinical symptoms, localization of LNH (ileum vs ileum plus colon), positive allergy tests, were recorded. Conclusions: In our study, all treatments were equally effective in improving symptoms related to LNH, not supporting the hypothesis of a correlation between LNH and FA. Our data suggest that LNH may be a benign, self-limited condition, possibly normal or age-related. Nevertheless large, prospective, controlled studies are needed to better define its clinical significance and its association with food allergy.

The peanut allergy in patients suffering from atopic dermatitis

Aim. The evaluation of the occurrence of peanut allergy in adolescent and adult patients suffering from atopic dermatitis. Methods. Altogether 175 persons suffering from atopic dermatitis were included in the study. A diagnostic work-up for food allergy to peanuts was performed (specific IgE, skin prick tests, atopy patch tests, history), and the patients were also examined for pollen allergy containing Bet v 1 and Bet v 2 allergens. Results. Allergic reactions to peanuts were recorded in 23% of patients, and another 16% of patients were sensitised to peanuts. A dependency between the occurrence of pollen allergy with Bet v 1 and Bet v 2 allergens and the results of the examination for peanut allergy is confirmed in our study. Conclusion. One-fifth of patients with atopic dermatitis suffer from peanut allergy; the most common symptom is oral allergy syndrome.

What has changed in the diagnostic approach?

Food allergy in general, and CMA in particolar, are an unique case in which a systematic approach can be applied even to single cases. As the disease involves not only the patient, but the whole family and her social supports, these can be protagonist of the diagnosis itself. As in any field of medicine, diagnosis starts from the suspicion. In patients reports for milk allergic reactions, an accurate medical history can clarify many aspects of the diagnosis. If history does not exclude the possibility of a CMA, in particular in delayed manifestations, in primary setting there is the possibility to take a period of tentative avoidance of milk, followed by an open re-introduction. When avoidance coincides with symptom-free periods, an open reintroduction can be useful to identify the offending food (if severe symptoms are anticipated, the procedure should be done under supervision in a medical facility). This elimination - reintroduction phase does not eliminate the necessity of challenge tests, but can give some indication on the possibility of CMA. We have several methods to evaluate milk sensitization. Basically, they are: - Skin testing, including immediate skin prick test (SPT), intradermal reactions and atopy patch test (APT) - The evaluation of serum food -specific IgE using one of the several methods we have at disposition. Performance, accuracy, and the diagnostic positioning of these have been afforded in the DRACMA Guidelines. Following these analysis, the following considerations can be formulated: • Challenge is the best for diagnosing CMA • If not available, challenge is not necessary in case of: a. high pre-test probability and SPT+ (classify as CMA) b. high pre-test probability and sIgE+ (classify as CMA) c. low pre-test probability and SPT- (exclude CMA) d. low pre-test probability and sIgE- (exclude CMA). • Challenges remain necessary in all cases of uncertainity (medium pre-test probability) • If challenge is necessary out of a research setting, sensitisation tests may not be necessary. • Atopy patch test is not useful • Component-resolved diagnosis may be useful, but further data are necessary • Molecular diagnosis may be useful, but more data are needed.

Atopic dermatitis and food allergy: when and how to test

Food allergy may provoke flares of atopic dermatitis. The prevalence of food allergy in infants with atopic eczema (AE) may be estimated at 40%. Most of cases of food allergies concern young children (infants aged under one year), and affected by recur eczema under appropriate treatment. Cow's milk, hen' eggs and wheat’ flours are the main food allergens involved in food allergies associated with AE. Food allergies can be identified by clinical history, skin prick test and, IgE specific assays, and the diagnosis confirmed by double-blind, placebo-controlled food challenges (DBPCFC). Oral food challenge is the gold standard to diagnose food allergy in the majority of cases. Nevertheless, method used for oral food challenge should be prolonged on several days according to the late eczematous reactions. Atopy Patch Testing is an approach to diagnose food-induced eczema when the immediate allergic tests are negative. When an allergy is diagnosed, the elimination of an offending food allergen should be added to the medical management of AE. Food can induce eczematous lesions in young children. Risk factors of food allergy are young age, moderate to severe AE and early onset of AE. Allergic testing recommendations should be done to prove that relationship.

Atopic dermatitis and food allergy: when and how to test?

Atopic dermatitis is a multifactorial skin disease. Epidermal barrier dysfunction, bacterial colonisation, psychological stress, but also type I allergens may aggravate this chronic remittent skin disease. Food allergens may play a role as aggravating factors in a subgroup of patients with atopic dermatitis, however the elicitating allergen profile differs between children and adults. In children such potential food allergens are milk, egg and wheat. These allergens are rarely of importance in adults. Here, if present, more frequently pollen associated food allergens may play a role as an aggravating factor. In principal much more patients assume allergic reactions against food being responsible for triggering eczematous reactions worsening the eczema. Therefore the identification of such patients who indeed will benefit from an elimination diet is important and will also result in the avoidance of unnecessary diets. The gold standard for the diagnosis of food dependent reactions is the performance of a placebo controlled, double blind oral provocation test because specific IgE, skin prick test and the patients history often do not correlate with clinical reactivity. In particularly in atopic eczema such procedure is extremely important for differentiation between food as a cause of a trigger of delate eczematous skin reactions. Before the performance of an oral provocation test a diagnostic elimination diet over a limited time frame is necessary. If several sensitisations are suspected an oligo allergenic diet and afterwards a subsequent implementation of defined food items can be performed. If the diagnostic elimination diet improves the severity of the eczema e.g. measured by SCORAD score oral provocation tests should be performed. As late phase reactions may develop slowly it is recommended to assess the SCORAD score not only the day after the provocation test but also after 24 hours followed by a second provocation if the first one did not aggravate the eczema (increase of SCORAD at least of 10 points). In particular in children the clinical relevance of food allergens should be re-evaluated every one to two years as the development of tolerance in particular towards milk is possible. The value of the atopy patch test for the diagnosis of type I clinical relevant type I sensitisation has been excessively studied, however due to the fact that no standardised extracts for testing are available it is not recommended for daily practise. In atopic eczema three clinical reaction patterns are possible (non-eczematous skin reactions e.g. urticaria, isolated eczematous delate skin reactions, excercabation of pre existing eczematous skin leasons after several hours or one to two days or a combination of non-eczematous early reactions and eczematous late reactions).

Allergic proctocolitis refractory to maternal hypoallergenic diet in exclusively breast-fed infants: a clinical observation

BackgroundAllergic proctocolitis (APC) in exclusively breast-fed infants is caused by food proteins, deriving from maternal diet, transferred through lactation. In most cases a maternal cow milk-free diet leads to a prompt resolution of rectal bleeding, while in some patients a multiple food allergy can occur. The aim of this study was to assess whether the atopy patch test (APT) could be helpful to identify this subgroup of patients requiring to discontinue breast-feeding due to polisensitization. Additionally, we assessed the efficacy of an amino acid-based formula (AAF) when multiple food allergy is suspected. amino acid-based formulaMethodsWe have prospectively enrolled 14 exclusively breast-fed infants with APC refractory to maternal allergen avoidance. The diagnosis was confirmed by endoscopy with biopsies. Skin prick tests and serum specific IgE for common foods, together with APTs for common foods plus breast milk, were performed. After a 1 month therapy of an AAF all patients underwent a follow-up rectosigmoidoscopy.ResultsPrick tests and serum specific IgE were negative. APTs were positive in 100% infants, with a multiple positivity in 50%. Sensitization was found for breast milk in 100%, cow's milk (50%), soy (28%), egg (21%), rice (14%), wheat (7%). Follow-up rectosigmoidoscopy confirmed the remission of APC in all infants.ConclusionsThese data suggest that APT might become a useful tool to identify subgroups of infants with multiple gastrointestinal food allergy involving a delayed immunogenic mechanism, with the aim to avoid unnecessary maternal dietary restrictions before discontinuing breast-feeding.

Toward a standardized reading of the atopy patch test in children with suspected cow’s milk allergy‐related gastrointestinal symptoms

AllergyVolume 66, Issue 11 p. 1499-1500 ALLERGY Net Toward a standardized reading of the atopy patch test in children with suspected cow’s milk allergy-related gastrointestinal symptoms R. Berni Canani, Corresponding Author R. Berni Canani Department of PediatricsEuropean Laboratory for the Investigation of Food-Induced DiseasesUniversity of Naples “Federico II”Via S. Pansini 5 80131 NaplesItalyTel.: +390817462680/3266Fax: +390815451278E-mail: berni@unina.itSearch for more papers by this authorA. Buongiovanni, A. BuongiovanniSearch for more papers by this authorR. Nocerino, R. NocerinoSearch for more papers by this authorL. Cosenza, L. CosenzaSearch for more papers by this authorR. Troncone, R. TronconeSearch for more papers by this author R. Berni Canani, Corresponding Author R. Berni Canani Department of PediatricsEuropean Laboratory for the Investigation of Food-Induced DiseasesUniversity of Naples “Federico II”Via S. Pansini 5 80131 NaplesItalyTel.: +390817462680/3266Fax: +390815451278E-mail: berni@unina.itSearch for more papers by this authorA. Buongiovanni, A. BuongiovanniSearch for more papers by this authorR. Nocerino, R. NocerinoSearch for more papers by this authorL. Cosenza, L. CosenzaSearch for more papers by this authorR. Troncone, R. TronconeSearch for more papers by this author First published: 14 July 2011 https://doi.org/10.1111/j.1398-9995.2011.02674.xCitations: 15 Erythema plus papules at APT has high diagnostic accuracy in children with CMA-related gastrointestinal symptoms 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 Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume66, Issue11November 2011Pages 1499-1500 RelatedInformation

The Expression of BAFF, APRIL and TWEAK Is Altered in Eczema Skin but Not in the Circulation of Atopic and Seborrheic Eczema Patients

The TNF family cytokines BAFF (B-cell activating factor of the TNF family) and APRIL (a proliferation-inducing ligand) are crucial survival factors for B-cell development and activation. B-cell directed treatments have been shown to improve atopic eczema (AE), suggesting the involvement of these cytokines in the pathogenesis of AE. We therefore analyzed the expression of these TNF cytokines in AE, seborrheic eczema (SE) and healthy controls (HC). The serum/plasma concentration of BAFF, APRIL and a close TNF member TWEAK (TNF-like weak inducer of apoptosis) was measured by ELISA. The expression of these cytokines and their receptors in skin was analyzed by quantitative RT-PCR and immunofluorescence. Unlike other inflammatory diseases including autoimmune diseases and asthma, the circulating levels of BAFF, APRIL and TWEAK were not elevated in AE or SE patients compared with HCs and did not correlate with the disease severity or systemic IgE levels in AE patients. Interestingly, we found that the expression of these cytokines and their receptors was altered in positive atopy patch test reactions in AE patients (APT-AE) and in lesional skin of AE and SE patients. The expression of APRIL was decreased and the expression of BAFF was increased in eczema skin of AE and SE, which could contribute to a reduced negative regulatory input on B-cells. This was found to be more pronounced in APT-AE, the initiating acute stage of AE, which may result in dysregulation of over-activated B-cells. Furthermore, the expression levels of TWEAK and its receptor positively correlated to each other in SE lesions, but inversely correlated in AE lesions. These results shed light on potential pathogenic roles of these TNF factors in AE and SE, and pinpoint a potential of tailored treatments towards these factors in AE and SE.

Egg allergy in patients over 14 years old suffering from atopic eczema

The aim of this study was to evaluate the occurrence of egg allergy in patients over 14 years old suffering from atopic eczema and especially to evaluate if egg allergy can deteriorate the course of atopic eczema in this group of patients. Altogether 179 patients suffering from atopic eczema were included in the study: 51 men and 128 women, with an average age of 26.2 years (SD 9.5 years), with median SCORAD 31.6 (SD 13.3) points. A complete allergological and dermatological examination was performed on all patients, including diagnostic work-up of food allergy to egg [skin prick tests, atopy patch tests (APTs), measurement of specific IgE level to egg yolks or whites]. Open exposure test (OET) with egg was performed in patients with positive results in some of these diagnostic methods. Food allergy to egg was determined according to positive results in the OET or according to sufficient anamnestical data about the severe allergic reaction after the ingestion of an egg. An allergy to egg was confirmed in 11 patients out of 179 (6%). Of these patients, only six (3.3%) had a clear improvement in the SCORAD after the elimination of egg. Other triggering factors may cause exacerbation of the atopic eczema in the patients enrolled in the study. Twenty-eight percent of patients were only sensitized to egg without clinical symptoms. ATPs were a useful tool in the diagnosis of food allergy to egg in patients without IgE reactivity. Egg allergy may play an important role in the worsening of atopic eczema acting as a triggering-exacerbating factor in a minority of patients. The diagnostic work-up may comprise the challenge tests to confirm the food allergy to egg.

Negative Atopy Patch Test and Negative Skin Prick Test Reduce the Need for Oral Food Challenge in Children with Atopic Dermatitis.

Atopic dermatitis (AD) is commonly associated with food allergy. Oral food challenge is the gold standard in the diagnosis of food allergy, but still has some troubles. The aim of this study was to evaluate whether a single test among skin prick test (SPT), measurement of specific immunoglobulin E (IgE), and atopy patch test (APT) or a combination of them could make food challenges unnecessary in patients with AD. Twenty patients affected by AD, under 6 years of age, were evaluated. Every child was investigated for cow's milk and hen's egg allergy using SPT, measurement of serum IgE (sIgE), APT, diagnostic elimination diet for 4 weeks, and open food challenges for milk and egg. The diagnosis of food allergy was established according to the results of the food challenge. We compared the results of all the tests with those of the open food challenge and calculated for each test the following parameters: sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Eight of 40 open food challenges were assessed as positive. None of the diagnostic tools showed a sufficient accuracy to be able to replace the food challenge. However, SPT, APT, and the measurement of sIgE as single parameters showed an NPV of 90%, and the combination of SPT and APT showed an NPV of 92%. Food challenge remains the gold standard for food allergy diagnosis in young children with AD, but the combination of SPT and APT is useful when both tests are negative, because this result provides a guidance in excluding an allergy to the investigated food and could make the food challenge superfluous in this case.

Autoreactive CD4+ T cells in patients with atopic dermatitis

Autoreactive CD4+ T cells in patients with atopic dermatitis

Food allergy-related paediatric constipation: the usefulness of atopy patch test

The aims of this study were to evaluate the implication of food allergy as a cause of paediatric constipation and to determine the diet period needed to tolerate the constipation-causing foods. Fifty-four children aged 6 months to 14 years (median, 42 months) suffering from chronic constipation (without anatomic abnormalities, cοeliac disease or hypothyroidism), unresponsive to a 3-month laxative therapy, were prospectively evaluated. All participants were evaluated for allergy to cow's milk, egg, wheat, rice, corn, potato, chicken, beef and soy, using skin tests (SPT), serum specific IgE and atopy patch test (APT). A withdrawal of the APT-positive foods was instructed. Thirty-two children had positive APT; 15 were positive to one; six, to two and 11, to three or more food allergens, wheat and egg being the commonest. After withdrawing the APT-positive foods for an 8-week period, constipation had improved in 28/32 children, but a relapse of constipation was noticed after an oral food challenge, so they continued the elimination diet. Tolerance to food allergens was achieved in only 6/28 after 6 months, compared to 25/28 after 12 months and to all after a 2-year-long elimination. Food allergy seems to be a significant etiologic factor for chronic constipation not responding to treatment, in infants and young children. APT was found to be useful in evaluating non-IgE allergy-mediated constipation, and there was no correlation of APT with IgE detection. Tolerance was adequately achieved after 12 months of strict food allergen elimination.

The atopy patch test: is it time to redefine its significance?

The atopy patch test (APT) was recently defined as an important tool in the diagnosis of atopic eczema/dermatitis syndrome (AEDS). Recent data showed that the APT may be positive also in patients with rhinitis or asthma. We examined the mechanisms that could underlie such findings. To locate relevant articles pertaining to the use of APT, MEDLINE databases from 1989 (when the APT was first introduced) to the present were searched. Articles concerning the results of APT in patients with AEDS and with rhinitis or asthma attributable to sensitization to inhalant allergens were examined. Recent data show that APT to dust mites is frequently positive, and it may be the only positive test, not only in subjects with AEDS but also in subjects with only respiratory symptoms (rhinitis, asthma) and a history of AEDS. Instead, positive skin prick tests and in vitro immunoglobulin (Ig) E tests prevail in patients with a negative history for AEDS. Based on the pathophysiology of AEDS, in which the mechanisms of delayed hypersensitivity are predominant, the APT seems to have a greater significance than skin prick tests or in vitro IgE tests in patients with current or past history of AEDS. That different sensitization mechanisms underlie these different clinical expressions seems conceivable. In particular, if mite allergens enter the skin in the presence of a filaggrin-dependent skin barrier dysfunction, the sensitization mechanism seems to be ultimately revealed by a positive APT.

Les tests épicutanés chez les patients atteints de dermatite atopique : les atopy patch tests

The exposure of atopic dermatitis (AD) patients to aeroallergens or food allergens can exacerbate or maintain the disease. Atopy patch tests (APTs) are able to identify these triggering factors and consist of the epicutaneous application of allergens for 48hours, with an evaluation of the eczematous lesions induced after 48 and 72hours, according to the reading criteria of the European Task Force on Atopic Dermatitis (ETFAD). APTs show a higher specificity than skin prick and specific IgE tests, since the pathophysiological mechanism of the reaction induced is very similar to what occurs in AD lesions. The standardization of APTs to aeroallergens has brought a certain reliability to this method, which is not the case for food APTs, for which the positive predictive value must be improved to avoid any unnecessary dietary restrictions. Thus, optimization of APTs and progress into knowledge of the pathophysiology of eczemas could help to develop new immunobiological diagnostic methods and AD specific immunotherapy.

Allergy to cow’s milk proteins: what contribution does hypersensitivity in skin tests have to this diagnosis?

Food allergy is an immunologically mediated adverse reaction to food protein. Cow's milk protein allergy (CMPA) is the most frequent type and is the one that is most difficult to diagnose. This study had the objective of analyzing the accuracy of hypersensitivity and specific IgE skin tests among children with CMPA and predominantly gastrointestinal clinical manifestations. The participants in this study were 192 children aged one and five (median of 2 yr). Among these, 122 underwent open oral challenge to the suspected food. After evaluating the sensitivity, specificity and positive and negative predictive values (respectively, PPV and NPV) of skin and specific IgE tests in relation to the gold standard (open oral challenge); all the children underwent the skin prick test (SPT), specific IgE test and atopy patch test (APT) for cow's milk, eggs, wheat and peanuts and the open oral challenge for the food to which the child was sensitive or had suspected sensitivity. Presence of food allergy was confirmed for 50 children (40.9%). Among these cases, 44/50 (88%) were of allergy to cow's milk protein. Children who presented a positive response to an oral challenge to cow's milk protein were considered to be cases, while the controls were children with negative response. Twenty-two of the 44 cases (50.0%) presented symptoms within the first 4 h after the challenge. The SPT presented 31.8% sensitivity, 90.3% specificity, 66.7% PPV and 68.4% NPV. The APT presented 25.0% sensitivity, 81.9% specificity, 45.8% PPV and 64.1% NPV. The specific IgE test presented, respectively, 20.5%, 88.9%, 52.9% and 64.6%. Despite the operational difficulty and the possible exposure risk, oral challenge is the best method for diagnosing CMPA, because of the low sensitivity and PPV of skin and specific IgE tests.

Food Allergy Related Pediatric Constipation: Appropriate Time Of Tolerance

RATIONALE: The aim of this study was to assess the relation between food allergy and pediatric constipation and to determine the timing of achieving tolerance in these patients. METHODS: Fifty-four children (median age 25 months) with chronic constipation, not responding to 3 months laxative therapy, were included (group I). As controls were used twenty healthy children (group II). Serum specific IgEs to cow milk, egg, wheat, rice, corn, and soy were measured with the CAP-FEIA. Skin prick and atopy patch tests were performed for the same allergens. RESULTS: All children in the control group had negative CAP, SPT and APT to all food allergens. In group I 26/54 children (48%) had positive APT. Of these, 10/26 (38%) were APT and CAP positive, while 8/26 (30%) were APT and SPT positive. Of the 26 APT positive children 8 (8/26, 30%) had positive APT to one food allergen, 10/26 (38%) had positive APT to two food allergens and 8/26 (30%) to 3 or more food allergens. Positive APT to egg was found in 17/26, to wheat in 16/26, to soy in 9/26, to cow milk in 8/26, to rice in 4/26 and to corn in 3/26. The cumulative percentage of patients achieving tolerance was 19% at 6 months, 78% at 12 months and 100% at 24 months of elimination CONCLUSIONS: Food allergy seems to be a significant etiologic factor for constipation in infants and young children. Based on this study, approximately 3 out of 4 patients achieved tolerance within the first 12 months of strict food allergens elimination

Staphylococcal Alpha-Toxin Is a Strong Inducer of Interleukin-17 in Humans

Patients with atopic dermatitis (AD) are frequently colonized with Staphylococcus aureus, with one-third of isolates producing alpha-toxin. Moreover, S. aureus colonization is positively correlated with the severity of eczema. Interleukin-17A (IL-17A) has gained attention in diseases associated with chronic skin infections. The aim of this study was to investigate the effects of sublytic alpha-toxin concentrations on IL-17A production. Sublytic alpha-toxin concentrations strongly induced IL-17A in peripheral blood mononuclear cells (PBMCs), isolated CD4(+) T cells, polarized Th17 cells, and Th17 clones from reactive atopy patch test lesions and blood from AD patients. Alpha-toxin induced IL-17A directly in T cells. The effect of alpha-toxin was further amplified by upregulation of IL-1 in monocytes. In conclusion, higher levels of IL-17A secretion induced by alpha-toxin in the skin partially explain how colonization with S. aureus can contribute to chronic skin inflammation.

CD8 + T cells are recruited early to allergen exposure sites in atopy patch test reactions in human atopic dermatitis

CD8 + T cells are recruited early to allergen exposure sites in atopy patch test reactions in human atopic dermatitis

Do Other Components of Bedding Dust Affect Sensitisation to House Dust Mites?

Bedding dust is a mixture of many components, of which the house dust mite (HDM) allergen, Der p 1, is the most allergenic. There has been little work to investigate the effect of other bedding dust components on HDM sensitisation. The objective of the study was to determine the effect of endotoxin in bedding dust on the allergic response in HDM-sensitised individuals. Twenty-nine house dust mite-sensitised adults were skin prick and allergen patch tested against a sterile solution of their own bedding dust and against a solution containing the same concentration of Der p 1 as the bedding solution for comparison. There was no significant difference in wheal size between the diluted house dust mite solution and the bedding dust in spite of their high levels of endotoxin. Symptomatic subjects had larger, but not statistically significant, responses to commercial house dust mite solution than asymptomatic subjects. Allergen patch test responses were negative in 22/29 of subjects using either bedding dust solutions or comparable diluted house dust mite solutions. An individual's own bedding dust does not appear to contain factors that enhance skin prick test or atopy patch test responses to house dust mites.