Atopy Patch Test Research Articles

Atopy patch test and specific IgE against chicken egg white and egg yolk in atopic dermatitis pediatric patients with a history of chicken egg allergy

Chicken eggs are one of the food allergens in children. Chicken eggs are contained in many foods; people consume eggs without separating the egg white and the egg yolk. Separating allergens in egg white and egg yolk through an allergy test is expected to specifically determine which allergen can cause allergies. This study determined the profile of Atopy Patch Test (APT) and specific IgE against chicken egg white and egg yolk in 20 atopic dermatitis patients with a history of chicken egg allergy. 2/20 subjects showed positive atopy patch tests against chicken egg white only, 1/20 subject was positive against egg yolk only, and 10 subjects (50%) were APT positive against both chicken egg white and yolk. Meanwhile, based on the value of the specific IgE, 2 subjects (10%) experienced an increase of the specific IgE against egg white only and 2 subjects experienced an increase of the specific IgE against both egg white and yolk. By separating allergens in both APT and serum specific IgE, the results obtained can be more vivid. These results may be used to educate patients who might be allergic to one of the allergens of chicken eggs.

Low efficacy of atopy patch test in predicting tolerance development in non-IgE-mediated cow's milk allergy

BackgroundThe food atopy patch (APT) test has been used in previous studies to help the diagnosis of non-IgE mediated food allergies (FA). The aim of this study was to evaluate the efficacy of different cow's milk APT preparations to predict oral tolerance in children with previous non-IgE-mediated cow's milk allergy (CMA) diagnosis. MethodsThirty-two patients non-IgE-mediated CMA diagnosed by oral food challenge (OFC) were enrolled to perform APT with three different cow's milk preparations (fresh, 2% in saline solution, 2% in petrolatum) and comparing with a new OFC after at least three months of diet exclusion. ResultsOnly six (18.7%) subjects presented positive OFC to cow's milk. No differences in gender, onset symptoms age, OFC age, Z-score, and exclusion period were found between positive and negative OFC patients. Preparations using fresh milk and powdered milk in petrolatum presented sensitivity equal to zero and specificity 92.3% and 96.1%. The preparation using powdered milk in saline solution showed sensitivity and specificity of 33.3% and 96.1%. Two patients presented typical IgE symptoms after OFC. ConclusionCow's milk APT presented a low efficacy to predict tolerance in patients with previous non-IgE-mediated CMA and should not be used in clinical routine. The presence of typical IgE reactions after OFC hallmark the necessity of previous IgE-mediated investigation for this patient group.

Epicutaneous allergen application preferentially boosts specific T cell responses in sensitized patients

The effects of epicutaneous allergen administration on systemic immune responses in allergic and non-allergic individuals has not been investigated with defined allergen molecules. We studied the effects of epicutaneous administration of rBet v 1 and rBet v 1 fragments on systemic immune responses in allergic and non-allergic subjects. We conducted a clinical trial in which rBet v 1 and two hypoallergenic rBet v 1 fragments were applied epicutaneously by atopy patch testing (APT) to 15 birch pollen (bp) allergic patients suffering from atopic dermatitis, 5 bp-allergic patients suffering from rhinoconjunctivitis only, 5 patients with respiratory allergy without bp allergy and 5 non-allergic individuals. Epicutaneous administration of rBet v 1 and rBet v 1 fragments led to strong and significant increases of allergen-specific T cell proliferation (CLA+ and CCR4+T cell responses) only in bp-allergic patients with a positive APT reaction. There were no relevant changes of Bet v 1-specific IgE and IgG responses. No changes were noted in allergic subjects without bp allergy and in non-allergic subjects. Epicutaneous allergen application boosts specific T cell but not antibody responses mainly in allergic, APT-positive patients suggesting IgE-facilitated allergen presentation as mechanism for its effects on systemic allergen-specific immune responses.

Tolerance to baked and fermented cow's milk in children with IgE-mediated and non-IgE-mediated cow's milk allergy in patients under two years of age

BackgroundIgE-mediated cow's milk allergy (CMA) has been shown consistent in milder heated-milk tolerant and severe heated-milk reactant groups in patients older than two years. Little is known whether fermentation of milk gives rise to similar clinical phenotypes.We aimed to determine the influence of extensively heated and fermented cow's milk on the IgE-mediated and non-IgE-mediated CMA in children younger than two years. MethodsSubjects followed with the diagnosis of IgE-mediated and non-IgE-mediated CMA for at least six months underwent unheated milk challenge. IgE-mediated and non-IgE-mediated groups were categorised as unheated milk-reactive and tolerant, separately. Unheated milk-reactive groups were further challenged sequentially with fermented milk (yoghurt) and baked milk, 15 days apart. Allergy evaluation with skin tests, prick-to-prick tests and atopy patch tests were performed. ResultsFifty-seven children (median age: 14 months; range: 7–24 months) underwent unheated milk challenge. Eleven of 27 children with IgE-mediated CMA and 14 of 30 children with non-IgE-mediated CMA tolerated unheated milk. Among subjects who reacted to unheated milk; 15 of 16 subjects (93%) with IgE-mediated CMA also reacted to yoghurt, whereas 11 of 16 subjects (68%) with non-IgE-mediated CMA tolerated fermented milk. Thirteen subjects (81%) of the unheated milk-reactive IgE-mediated group tolerated to heated milk. None of 16 subjects of unheated milk-reactive non-IgE-mediated group reacted to baked milk. ConclusionThe majority of children under the age of two years with both IgE-mediated and non-IgE-mediated CMA tolerated baked-milk products. Yoghurt was tolerated in two thirds of unheated milk reactive patients suffering from non-IgE-mediated CMA.

Kronik Kabızlığı Olan Çocuklarda Besin Allerjisinin Rolü

Objective: We aimed to evaluate the role of food allergies in the etiology of constipation in children who presented with chronic constipation. We investigated the effects of the allergens on constipation by eliminating the relevant allergen from diet in cases with positive food allergy testing in the study. Materials and Methods: The study included 75 patients aged 6 months-10 years with functional constipation. The severity of constipation was assessed with the constipation symptom score. Food-specific IgE levels were evaluated in the sera while skin prick and atopy patch tests were performed by using milk, egg white, egg yolk, wheat, and soybean in all patients. For the patients with positive test results, the allergen was eliminated from the diet over 2 months. Two months later, these patients were re-evaluated by using the constipation symptom score. Results: There was a female predominance (62.7%) in the study group. The mean age was 4.69±0.295 (mean±SD) years. The mean duration of constipation was 24±2 (mean±SD) months. The atopy patch test was positive in 4 of the 75 (5.3%) patients. Atopy patch test positivity was found for egg white and yolk in the first patient, wheat and soy in the second, wheat alone in the third, and soy alone in the fourth. The skin prick test was found to be negative in all four patients. Food mixed specific IgE levels were positive in three of the four patients with a positive atopy patch test (2.31kU/L, 2.35 kU/L, 0.1 kU/L and 1.16 kU/L, respectively). When patients were reevaluated after an elimination diet by using the constipation symptom score, the symptom score had improved in only one patient, the one with soy allergy. Conclusion: Our findings support that food allergy has no role in chronic constipation. The atopy patch test did not make an additional contribution to the diagnosis of food allergy.

Effects of food allergens on asthma exacerbations in schoolchildren with atopic asthma

ABSTRACTAlthough the prevalence with which food causes asthma is not well known, food allergy is implicated in a variety of respiratory symptoms. Eighty-two asthmatic children aged 6–16 years with doctor-diagnosed sensitization to inhalants and presenting with asthma exacerbation participated in this study of food allergies linked to asthma exacerbations. The diagnosis of food allergy was established using a questionnaire, clinical criteria, serum-specific IgE antibody measurements, and an atopy patch test. Asthma exacerbation was determined using fractional exhaled nitric oxide management after the children were admitted to the hospital. On the basis of questionnaire data, suspected food allergy was identified in 59.8% children. The positive and negative rates of serum food-specific IgE tests were 54.9% and 45.1%, respectively. The results of atopy patch tests in radioallergosorbent-positive participants were 88.9% positive and 12.5% negative. Food allergy is a risk factor for asthma exacerbation, and evaluation of food allergy in selected patients with asthma is indicated.

Atopy patch test in children with atopic dermatitis

BackgroundAtopic dermatitis is frequently associated with food and/or aeroallergen allergy. ObjectiveTo evaluate atopy patch tests (APTs) and skin prick tests (SPTs) in children with atopic dermatitis, using allergen extracts from locally lyophilized foods (cow's milk, egg white, egg yolk, wheat, soy, and shrimp), Dermatophagoides pteronyssinus, Dermatophagoides farinae, and American cockroach. MethodsThis study was a prospective, self-controlled study in children with atopic dermatitis. APTs, SPTs, and oral food challenge tests were performed in the cases with written informed consent. ResultsFifty-six children with atopic dermatitis were enrolled. According to the Severity Scoring of Atopic Dermatitis Index, moderate atopic dermatitis was the most common severity (49.1%) followed by mild (20%) and severe atopic dermatitis (13.2%). APT results were positive for food allergens in 49% of participants; SPT results were positive in 54.7%. The sensitivity, specificity, positive predictive value, and negative predictive value of APTs for foods were 40%, 90.2%, 65.2%, and 76.6%, respectively. For SPTs, those values were 40%, 93.9%, 75%, and 77.3%, respectively. APT results for D farinae, D pteronyssinus, and American cockroach were positive in 33.9%, 35.8%, and 21.8% of participants, respectively. SPT results for these allergens were positive in 28.3%, 24.5%, and 9.4% of participants, respectively. No serious complications occurred. ConclusionAPTs with locally prepared lyophilized allergen extracts were safe and had high specificity, median positive predictive value, and low sensitivity for evaluation of suspected food allergy in children with atopic dermatitis. Trial Registrationclinicaltrials.gov Identifier: NCT01164293

Sensitivity and specificity of specific IgE, skin prick test and atopy patch test in examination of food allergy

ABSTRACTThe aim of this study is the evaluation of the specificity and sensitivity of the skin prick tests (SPTs), specific IgE and atopy patch tests (APTs) in atopic dermatitis patients suffering from food allergy. A total of 301 patients were examined, complete dermatological and allergological examination was performed in all patients. The food allergy was confirmed to peanuts in 62 patients (20%), to egg in 16 patients (5%), to soy in 9 patients (3%), to wheat in 12 patients (4%) and to cow milk in 6 patients (2%). The specificity of SPT, specific IgE and APT is considered as good; the sensitivity of APT is low. The positive results in isolation cannot confirm the food allergy; however, together with other diagnostic methods, such as clinical history and open exposure test, these tests are valuable tool in examination of food allergy.

Atopy patch test in examination of food allergy in patients suffering from atopic dermatitis

ABSTRACTAim: The evaluation of the importance of atopy patch tests in patients suffering from food allergy to egg’s white and yolk, peanuts, soy, cow’s milk and wheat. Methods: 240 patients were examined. Complete dermatological and allergological examination was performed in all patients including specific IgE, skin prick test, atopy patch test and the challenges tests. Results: The specificity of atopy patch tests is for soy 96%, for egg 95%, for wheat 95%, for peanuts 99% and for milk 99%. The sensitivity of atopy patch tests is for soy 62%, for egg 35.7%, for wheat 16.7%, for peanuts 20.8% and for milk 50%. Conclusion: The specificity of atopy patch tests may be considered good; regarding the sensitivity, the high percentage of false negative results should make us believe that these tests are not conclusive.

Atopy patch test with house dust mite in Chinese patients with atopic dermatitis.

The atopy patch test (APT) has been defined as an important tool in the diagnosis of cutaneous hypersensitivity caused by house dust mites in atopic dermatitis (AD). The aim of this study was to evaluate the diagnostic value of the APT to mite allergens by comparing its positive results with those of the skin prick test (SPT) and serum specific IgE test in Chinese AD patients. The APT, SPT and serum specific IgE test with Dermatophagoiodes pteronyssinus and Dermatophagoides farina were performed on a total of 120 patients with atopic dermatitis. Overall, 37.5% of the patients showed a positive APT reaction to mite allergens. A statistically significant association was observed between positive APT results and air-exposed eczema pattern. The positive APT results were not significantly associated with SCORAD scores and accompanied atopic respiratory disorders in AD patients. A higher frequency of APT positive reactions to mite allergens was observed in adolescent and adult patients. There was no significant difference in APT positivity between extrinsic patients (40.7%) and intrinsic patients (27.6%). This study identified house dust mite induced cutaneous hypersensitivity in Chinese patients with AD by APT, especially in air-exposed distribution patterns or adolescent and adult patients. Both intrinsic and extrinsic AD patients showed positive APT reactions to house dust mite.

Utility of the Atopy Patch Test in the Diagnosis of Allergic Rhinitis.

The diagnostic work-up of allergic rhinitis (AR) is first and foremost based on the combination of clinical history data and results of skin prick tests (SPT). Other tests, including specific IgE measurement, nasal challenge, and, as a third option, component resolved diagnosis or basophil activation test, may be useful when the diagnosis is difficult because of polysensitization or when negative results of SPT are observed despite a suggestive history for allergy. The atopy patch test (APT) that assesses the type 4 delayed hypersensitivity allergy is currently not sufficiently used. The data obtained in recent studies on the diagnostic utility of the APT in patients with AR was reviewed. Review of the literature. The data from available studies show that the APT is frequently positive in patients with AR, especially when there is a positive history for atopic dermatitis. Very often, APT is the only positive test and therefore performing only SPT or in vitro IgE measurement may lead to an erroneous diagnosis of nonallergic rhinitis. Recent data suggest a role for APT not only for diagnosis but also in epidemiological investigation on respiratory allergy.

Comparison of diagnostic tests for suspected cow's milk allergy in children with atopic dermatitis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease. A third of pediatric AD patients have also food allergy. Although food challenge test is gold standard test for the diagnosis of food allergies, they should be administered by experienced physicians, considering that the test is time-consuming and carries some risks. Documentation of the efficacies of specific IgE (sIgE), skin prick test (SPT), and atopy patch test (APT) are important for determining the necessity of oral food challenge tests(OFC). Fifty-three AD patients with suspected cow's milk allergy (CMA) were included in our study. Diet-related questions were asked to the patients. Blood samples were taken for measurement of total blood count, total IgE, and milk sIgE. OFC, SPT, and APT were performed using pasteurized cow milk. The mean age of the study population was 1.4±0.8 years, and the male:female ratio was 1.12. Cow milk allergy was detected in 45.3% of the patients after OFC. A comparison between CMA(+) and CMA(-) patients revealed no significant difference in sIgE positivity (P=0.940), but there was a significant difference in SPT (P=0.000) and APT (P=0.001) positivity. When our study group was divided into immediate reaction, delayed onset reaction, and not reactive subgroups after OFC, efficacy of SPT was more prominent in immediate reaction subgroup while APT was more efficient in delayed reaction subgroup. Our study showed that using SPT test with APT test in allergic reactions with IgE and other mechanisms such as AD will increase the diagnostic yield, thereby reducing the need for OFC.

Testy skórne punktowe i płatkowe w diagnostyce nadwrażliwości na pokarmy u niemowląt i małych dzieci – badanie pilotażowe

IntroductionIn the light of increasing frequency of food allergy in young children, it is important to choose optimal diagnostic methods. PurposeTo ascertain the usefulness of skin prick tests with synthetic and natural allergens and atopy patch tests in children up to 3 years of age with the suspicion of food hypersensitivity. Patients and methodsFor the analysis, we included 53 children up to 3 years of age, with symptoms suggesting food allergy. On the basis of an interview, we established the set of allergens to test. ResultsThe highest percentage of positive results were obtained respectively in atopy patch tests – for egg white, egg yolk, chicken, milk, carrot, and wheat; in skin prick test with native allergens – for egg white, and egg yolk; and in skin prick test with synthetic allergens – for milk, egg white, and egg yolk. The interviews and test results allowed to diagnose hypersensitivity to milk in 33.96% patients, egg white in 37.74%, egg yolk in 43.4%, wheat in 22.64%, chicken in 20.75%, celery and carrot in 18.87%, and potato in 16.98% patients. ConclusionsThe choice of the test type can be important to the diagnosis but differ for different types of food. Conducting diagnostic tests, which allow for combined assessment of IgE-mediated and non-IgE-mediated food allergy, including skin prick tests and patch tests, increases the chance of establishing an accurate diagnosis.

Analysis of selected allergic reactions among psoriatic patients.

IntroductionPsoriasis is a chronic and recurrent inflammatory skin disease. The aetiology is still unknown in spite of numerous scientific researches. There is very little evidence which does not provide enough knowledge about allergic reactions in psoriatic patients. Based on the fact that the epidermal barrier damage allows different allergen types to penetrate into deep layers of epidermis and skin, we can assume that it may lead to immunological reactions.AimTo investigate the allergic reaction indicators and hypersensitivity assessment about contact, inhalant and food allergens. The results were analysed with regard to clinical disease indicators and progression stage of dermal lesions.Material and methodsEighty patients with psoriasis were examined. The concentration of total IgE antibodies and allergen specific IgE antibodies (asIgE) were analysed. Standard epidermal tests and atopy patch tests were performed. All the patients were estimated for their dermatological condition based on the PASI scale. The control group consisted of 50 patients without psoriasis and allergic history.ResultsSignificantly higher concentration of total E immunoglobulin has been stated in the patients with psoriasis. Higher concentrations of specific allergic IgE antibodies were more often observed in the examined group but the most frequently observed values were present in 1–3 class. The most common airborne allergens were birch, artemisia, timothy and rye pollens. There have not been any significant statistical differences in the case of positive epidermal test results.ConclusionsThere is slightly expressed hypersensitivity in psoriatic patients. This hypersensitivity degree correlates with the intensification of symptoms.

Food allergy in children with refractory gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) and food allergy are frequent disorders of childhood. The purpose of this study was to determine the frequency of food allergy in children with refractory GERD. A total of 151 children resistant to pharmacologic GERD treatment underwent skin prick test, specific immunoglobulin E, eosinophil count, atopy patch test (APT), and oral food challenge, and were then divided into three groups according to the results of oral milk challenge and allergy work-up: group A1, positive oral milk challenge and positive IgE-mediated allergy test; group A2, positive milk challenge and negative IgE-mediated allergy test; and group B, negative oral milk challenge and negative allergy tests. There were 35, 30 and 86 patients in group A1, group A2 and group B, respectively. A total of 28 of 35 patients in group A1 had cow's milk allergy and the other seven patients had egg allergy. APT positivity was more common in group A2. Endoscopic esophagitis was observed in six group A1 patients and in four group A2 patients. Bloody stools, atopic dermatitis and recurrent wheezing episodes were significantly more common in group A1 than in group A2 and group B (P < 0.001, for both). Cow's milk allergy was observed frequently in children resistant to pharmacologic GERD treatment. Combined skin prick and specific IgE tests, APT and oral food challenge is essential for avoidance of unnecessary elimination diet.

Frequent occurrence of T cell–mediated late reactions revealed by atopy patch testing with hypoallergenic rBet v 1 fragments

BackgroundLate allergic reactions are common in the course of allergen-specific immunotherapy and even occur with allergy vaccines with reduced IgE reactivity.ObjectiveWe sought to study atopy patch test (APT) reactions and T-cell responses to the recombinant birch pollen allergen Bet v 1 and recombinant hypoallergenic T-cell epitope–containing Bet v 1 fragments in patients with birch pollen allergy with and without atopic dermatitis (AD).MethodsA clinical study was conducted in 15 patients with birch pollen allergy with AD (group 1), 5 patients with birch pollen allergy without AD (group 2), 5 allergic patients without birch pollen allergy (group 3), and 5 nonallergic subjects (group 4) by performing skin prick tests and APTs with rBet v 1 and hypoallergenic rBet v 1 fragments. T-cell, cutaneous lymphocyte antigen (CLA)+ and CCR4+ T-cell and cytokine responses were studied by thymidine uptake, carboxyfluorescein diacetate succinimidyl ester staining, and Luminex technology, respectively.ResultsrBet v 1 and hypoallergenic rBet v 1 fragments induced APT reactions in not only most of the patients with birch pollen allergy with AD (11/15) but also in most of those without AD (4/5). Patients with birch pollen allergy with AD had higher Bet v 1–specific proliferation of CLA+ and CCR4+ T cells compared with patients with birch pollen allergy without AD. There were no differences in Bet v 1–specific CLA+ and CCR4+ proliferation and cytokine secretion in patients with and without APT reactions.ConclusionHypoallergenic rBet v 1 fragments induce T cell–dependent late reactions not only in patients with birch pollen allergy with AD but also in those without AD, which can be determined based on APT results but not based on in vitro parameters.

Gluten psychosis: A case report and review of literature

Objectives: A singular report of non-celiac gluten sensitivity (NCGS) presenting with hallucinations has been described in an adult patient. We report the first pediatric case of a psychotic disorder clearly related toNCGS and investigate the causes by a review of literature. Case report: A 12 year-old girl reported daily headache, and behavior alterations. One month after, she began to have complex hallucinations. Screening for infectious, metabolic, autoimmune, and neurologic diseases resulted negative. A psychotic disorder wasdiagnosed. Treatmentwitha second-generationanti-psychotic was started but psychotic symptoms persisted. After 2 years, due to gastro-intestinal complaints, a nutritionist was consulted, and a gluten-free diet (GFD) was recommended; within a week both gastro-intestinal and psychiatric symptoms dramatically improved. After 5 months she was admitted to our outpatient. We performed a double-blind challenge test with wheat and rice flour. During the administration of rice flour, symptoms were absent. During the second day of wheat flour intake, the girl presented headache, halitosis, abdominal distension, mood disorders, and three episodes of severe hallucinations. After the challenge she tested negative for: CD serology, food specific-IgE, skin prick test to wheat, atopy patch test to wheat, duodenal biopsy. A GFD was started with a complete regression of all symptoms. Nine months after she is still symptoms-free. Conclusions: The present case-report confirms that psychosis may be a manifestation of NCGS, and may involve also children. Well-designed prospective studies are needed to establish the real role of gluten as a triggering factor in neuro-psychiatric disorders.

Food Avoidance Diets for Dermatitis.

Food allergy is relatively common in both children and adults, and its prevalence is increasing. Early exposure of food allergens onto skin with an impaired epidermal barrier predisposes to sensitization and prevents the development of oral tolerance. While immediate-type food allergies are well described, less is known about delayed-type food allergies manifesting as dermatitis. This is due, in part, to limitations with current diagnostic testing for delayed-type food allergy, including atopy patch testing. We conducted a systematic review of food avoidance diets in delayed-type food allergies manifesting as dermatitis. While beneficial in some clinical circumstances, avoidance diets should be used with caution in infants and children, as growth impairment and developmental delay may result. Ultimately, dermatitis is highly multifactorial and avoidance diets may not improve symptoms of delayed-type food allergy until combined with other targeted therapies, including restoring balance in the skin microbiome and re-establishing proper skin barrier function.

Characteristics and Prognosis of Allergic Proctocolitis in Infants.

The dietary protein proctocolitis, also known as allergic proctocolitis (AP), is characterized by the presence of mucoid, frothy, and bloody stools in an otherwise healthy infant. The aim of this study was to describe a group of children with AP, diagnosed according to the criterion-standard method, food challenge to provide clinicians with more information on typical presentation, and an overview on nutritional management strategies and prognosis. We collected data on infants with AP in our allergy and gastroenterology outpatient clinics. Any other conditions that may cause bloody diarrhea were ruled out. Skin prick tests and atopy patch tests were performed for diagnosis, and patients were studied for resolution. To the patients whose rectal bleeding did not recover with oligoantigenic maternal diet in addition to amino acid-based formula, endoscopic evaluation was performed to confirm the diagnosis and to exclude other reasons of rectal bleeding. Sixty patients were diagnosed as having AP. The age of onset was 1.7 ± 1.32 months. All of the patients were triggered by milk, 6.6% with milk and egg, 3.3% with milk and chicken, 1.7% with milk and wheat, 1.7% with milk and potato, and 3.3% had multiple food allergy. 53.3% (n = 32) acquired tolerance by age 1, 25.0% (n = 15) by 2 years, 5% (n = 3) by 3, and 1.7% (n = 1) by 4 years. Milk was a triggering factor for all of the patients. Resolution of AP is usually within 1 year but symptoms of some patients may continue even longer. An extension of the follow-up period is required according to our study.

Poor utility of the atopy patch test in infants with fresh rectal bleeding

Poor utility of the atopy patch test in infants with fresh rectal bleeding