Skin Prick Test In Children Research Articles

Systemic Reactions to Skin Prick Test with Food Allergens in Children.

Although skin prick tests (SPTs) are generally considered safe, limited studies have specifically evaluated reactions related to SPTs with all allergens. In contrast to these studies, our aim is to exclusively evaluate systemic reaction (SR) occurrences with food allergens during SPTs in children. All patients who underwent skin prick and/or prick-to-prick (PtoP) tests with food allergens at our clinic between January 2010 and January 2020 were included in the study. The occurrence of SR during SPTs was evaluated based on patient records. The study included 1852 patients, with 57% males and a median age of 31 months (1-210). Skin tests were most commonly conducted for the indication of atopic dermatitis (29.3%). During the study, 11.2% had repeat SPTs for tolerance and a new allergy diagnosis. No local reactions or SRs occurred during SPTs. Among those with PtoP tests, 3 patients (0.16%) experienced SRs-1 had anaphylaxis (0.05%), the rest had angioedema. Legumes and sea bass caused these reactions. In patients with severe index reactions and those who underwent PtoP testing, SR development was significantly higher (P < .001 for both), and anaphylaxis occurrence was significantly higher among those undergoing PtoP testing compared to prick testing alone (P = .03). The prevalence of both SR and anaphylaxis due to SPT with food allergens was found to be quite low in children. However, it is important to consider the possibility of SR development before conducting SPT with food allergens, especially in patients who will undergo the PtoP test and those with severe index reactions. Cite this article as: Karkın G, Ertoy Karagol Hİ, Polat Terece S, Köken G, Yapar D, Bakırtaş A. Systemic reactions to skin prick test with food allergens in children. Turk Arch Pediatr. 2024;59(1):54-59.

Sensitization pattern to various common allergens, using allergy skin prick test in children suffering from asthma and allergic rhinitis attending asthma outpatient department, at a tertiary care hospital in Central India

Background: Bronchial asthma is one of the most common chronic conditions of children. Allergy skin test, specific IgE levels can help to identify the triggers and better management. This observational study was carried to analyze the pattern of sensitization to various common allergens in children suffering from asthma and/ or allergic rhinitis at AIIMS, Raipur and to correlate sensitization with the various demographic parameters. Methods: Children between the age of one to 14 year diagnosed with asthma and/or allergic rhinitis were enrolled. They were subjected to skin prick test (SPT) using 18 common antigens. Induration more than 3mm than the negative control was considered as positive test. Results: 70 patients with an average age of 9.1 year were enrolled. 46 were males. Almost 80% (56) patients had sensitization to at-least one antigen tested. Highest sensitization was observed for cockroach mix 33 (58.92%) followed by Dermatophagoides farinae 18 (32.14%) and grain dust rice 16 (28.57%%). Sensitization was more in children with history of asthma in family (OR=2.37), residing near main road (OR=2.4), and in nuclear family (OR=1.54). There was no relation of SPT positivity with absolute eosinophil count (p=0.45, OR=0.41), family h/o allergic rhinitis (p=1.0, OR=0.86) and atopic dermatitis (p=1.0, OR=0.81). Statistically significant difference observed in the positivity of SPT in relation to severity of illness. (p=0.01, OR=0.162). Conclusions: Sensitization rate was high (80%) with cockroach mix being the commonest antigen. Family history of asthma, residence near main road and severity of illness were associated with higher sensitization.

Prevalence of IgE-Mediated Food Hypersensitivity to Cereals and Beans Based on Skin Prick Test in Children with Celiac Disease.

BACKGROUND Celiac disease is a non-IgE mediated food allergy, which can cause extensive villus atrophy. Because of increased food allergen absorption, there are elevated IgA and IgG antibodies in these patients, so there is a concern about IgE antibody production against wheat and other cereals. METHODS In this study, we evaluated IgE-mediated hypersensitivity to wheat, rice, and other cereals in children with celiac disease. RESULTS 22 patients (50%) had at least one positive skin prick test to food allergens. The most frequent food allergen was peanut (31.8%), followed by wheat (18.2%), corn (9.1%), and rice (4.5%). The results revealed no significant correlation between age, sex, and the results of the skin prick test (p >0.05). The correlation between diagnosis time of celiac disease and results of skin prick test was also not significant statistically (p >0.05). CONCLUSION Because of the high prevalence of IgE mediated hypersensitivity to cereals and beans in children with celiac disease, a skin prick test might be considered in these patients, especially in refractory cases.

The impact of skin prick testing on pain perception and anxiety in children and parents.

Skin prick testing (SPT) is a major diagnostic tool in patients with allergic symptoms. The testing process may involve pain, anxiety, and stress on children and parents. We aimed to measure the level of pain and anxiety before and after SPT in children and parents, and tried to identify predictive factors. The children underwent SPT and parents completed the State Trait Anxiety Inventory (STAI) S-Anxiety before and after SPT, T-Anxiety before SPT. The study nurse completed Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) scores (<5 years) or Wong-Baker FACES Pain Rating Scale (VAS), (≥5 years) after the SPT, in order to quantify pain. A total of 523 children (5.3 [2.8-9.1] [median, interquartile range] years old, 59.5% male) were evaluated. Parent gender was a predominant factor for anxiety, as mothers had a higher pre-test STAI (S-Anxiety) score, STAI (T-Anxiety), and post-test STAI (S-Anxiety) score than fathers (p < 0.001). Pre-test STAI (S-Anxiety) scores of parents decreased with increasing age (for 0-<5 years, 5-<12 years, and ≥12 years; [p for trend = 0.016]). The children tested on the back had higher VAS scores compared with the ones tested on the forearm [2[0-4] vs 2[0-2], [p = 0.005]). Risk factors determining higher general anxiety STAI (T-Anxiety) scores above the median were female sex for the parent (OR = 1.68; 95% CI [1.10-2.57]; p = 0.017), and parent's education level being greater than or equal to high school level (OR = 1.83; 95% CI [1.27-2.64]; p = 0.001). SPT may cause anxiety and pain in a subgroup of children particularly in younger age, and if performed on the back. Anxiety levels were higher in mothers, and in parents with high education levels.

Skin prick testing in children

There is an increasing incidence of allergies across all the ages in India. Pediatricians of the future will increasingly be encountering various allergic conditions. Accurate diagnosis of allergies depends very much on a detailed history supported by the judicious use of allergy tests. The two widely available allergic tests in our country are the skin prick testing (SPT) and serum-specific IgE. This article discusses in detail about the various aspects of SPT including the indications, technique of SPT, interpretation of the results, advantages, and limitations of SPT.

Low-dose peanut challenges can facilitate infant peanut introduction regardless of skin prick test size

The Learning Early About Peanut Allergy (LEAP) trial and other studies recommend early peanut introduction to prevent peanut allergy in at-risk infants. 1 Du Toit G. Roberts G. Sayre P.H. et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015; 372: 803-813 Crossref PubMed Scopus (1239) Google Scholar ,2 Perkin M.R. Logan K. Tseng A. et al. Randomized trial of introduction of allergenic foods in breast-fed infants. N Engl J Med. 2016; 374: 1733-1743 Crossref PubMed Scopus (497) Google Scholar In addition, peanut oral immunotherapy (OIT) shows increased rates of sustained unresponsiveness in children younger than 5 years with known peanut allergy, 3 Vickery B.P. Berglund J.P. Burk C.M. et al. Early oral immunotherapy in peanut-allergic preschool children is safe and highly effective. J Allergy Clin Immunol. 2017; 139: 173-181.e8 Abstract Full Text Full Text PDF PubMed Scopus (219) Google Scholar suggesting better outcomes with early exposure. The LEAP trial excluded infants with skin prick tests (SPTs) greater than 4 mm. 1 Du Toit G. Roberts G. Sayre P.H. et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015; 372: 803-813 Crossref PubMed Scopus (1239) Google Scholar The guidelines recommend peanut introduction or oral food challenge (OFC) only in infants who have SPTs less than or equal to 7 mm and do not specifically address management of infants with SPTs greater than 7 mm (or high peanut IgE levels). 4 Togias A. Cooper S.F. Acebal M.L. et al. Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. J Allergy Clin Immunol. 2017; 139: 29-44 Abstract Full Text Full Text PDF PubMed Scopus (252) Google Scholar Data suggest that patients with peanut SPT greater than 7 mm are likely to react, 4 Togias A. Cooper S.F. Acebal M.L. et al. Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. J Allergy Clin Immunol. 2017; 139: 29-44 Abstract Full Text Full Text PDF PubMed Scopus (252) Google Scholar ,5 Roberts G. Lack G. Diagnosing peanut allergy with skin prick and specific IgE testing. J Allergy Clin Immunol. 2005; 115: 1291-1296 Abstract Full Text Full Text PDF PubMed Scopus (227) Google Scholar but most reference values for SPT and peanut IgE levels are not standardized for infants. 5 Roberts G. Lack G. Diagnosing peanut allergy with skin prick and specific IgE testing. J Allergy Clin Immunol. 2005; 115: 1291-1296 Abstract Full Text Full Text PDF PubMed Scopus (227) Google Scholar ,6 Hill D.J. Heine R.G. Hosking C.S. The diagnostic value of skin prick testing in children with food allergy. Pediatr Allergy Immunol. 2004; 15: 435-441 Crossref PubMed Scopus (201) Google Scholar It is unknown whether infants with SPT greater than 7 mm may tolerate and benefit from early peanut exposure. Given the potential long-term benefits of tolerating peanut, we sought to offer peanut OFCs to a wider population of sensitized infants.

Clinical profile and skin prick test analysis in children with allergic rhinitis of North Kerala, India

Background: Allergic rhinitis (AR) is increasing in prevalence among children globally and in India. Allergens are factors which trigger allergic rhinitis. Skin prick test (SPT) is a rapid, sensitive and cost effective test to detect IgE- mediated allergic diseases. Identification of common aeroallergens in an area is necessary, in order to educate the patient on what allergens to avoid and also help find the best formulation of allergen immunotherapy for effective AR treatment. This study was done to find the clinical profile and skin sensitivity to common allergens by skin prick test in children with allergic rhinitis between six and fifteen years.Methods: This cross-sectional study was conducted for a period of one year from January 2016 to December 2016. All children between 6 to 15 years with allergic rhinitis were included in the study. Skin prick test was done with seven most common allergens.Results: A total of 60 children with allergic rhinitis were studied and 42 patients (70%) tested positive for SPT. The major symptoms were persistent sneezing (68%), nasal itching (33%), rhinorrhea (85%) and nasal congestion (42%). The proportion of sneezers-runners was higher than blockers (64% versus 36). We tested seven common allergens and house dust mite allergen yielded the highest number of positive responses (33%) followed by cockroach (25%), alternaria (16.66%), parthenium (10%), cat dander (8.35%), sorghum (5%) and dog dander (5%). Among patients with SPT positivity; eight were positive to one allergen, thirteen were positive to two allergens, sixteen to three allergens and five to four allergens.Conclusions: Allergic Rhinitis with a number of allergic co morbidities has a significant impact on the quality of life and scholastic performance in children. Skin prick test which is a standardized, most rapid, sensitive and cost-effective test to detect IgE-mediated allergic diseases is helpful in identifying the common allergens. House dust mite is the commonest allergen tested positive in our study in children.

Evaluation of the frequency of food allergens based on skin prick test in children in Kurdistan Province – Iran

IntroductionFood allergy refers to abnormal reactions of the body caused by an immune system response to food. This study was conducted aiming to investigate allergy to food allergens in children with food allergies. Materials and methodsThis study was conducted as a cross-sectional one on 304 children aged six months to seven years with food allergies admitted to the tertiary referral hospital in Kurdistan Province – Iran, during 2014–2015. All the patients were examined for skin prick test using 49 allergens. Finally, the obtained data were analysed using SPSS15 and chi-square and t tests. ResultsThe highest percentage of occurrence of bump reaction (wheal) and redness (flare) was due to the consumption of fish, eggs, tomatoes, and cocoa. Moreover, the lowest rate of wheal and flare was caused by exposure to allergens like latex, tea, malt, and wheat flour. The reaction most created due to the consumption of foods was flare which was higher among under three-year-olds group (p<0.05), and between the sexes, girls showed the most common allergic reactions (p<0.05). ConclusionSince food allergy has a high prevalence in children, it should be considered with great interest. Considering that avoiding food allergens is the first step in the treatment of food allergies, the present study may be a useful guide in this regard.

Prevalence study of common environmental allergens in children with asthma and allergic rhinitis in Kolkata: A hospital-based study

Background: Studies evaluating the role of skin prick testing (SPT) as the sole testing technique in children below 12 years of age involving a broader and more relevant group of aero- and food-allergens in this part of India are still lacking. Objectives: To identify the commonly prevalent environmental allergens by SPT in children with asthma as per British Thoracic Society and Scottish Intercollegiate Guidelines Network Criteria and allergic rhinitis (AR) as per British Society for Allergy and Clinical Immunology Criteria attending the OPD of a tertiary care pediatric unit in the eastern part of India. Methods: Testing of inhalant and food allergens by SPT in children from 4 to 12 years age group with asthma and AR satisfying the inclusion criteria. Results: Total 106 children (70 males and 36 females) were included in the study. Study of inhalant allergens in asthmatic patients revealed the highest positivity for house dust mite followed by male cockroach and among food allergens, highest positivity for egg/egg products, followed by milk/milk products. Study of inhalant allergens in asthmatic patients with coexistent AR revealed the highest positivity for house dust mite, cockroach male and female and among food allergens, highest for milk/milk products, egg/egg products, banana, and mustard. Conclusions: In Kolkata, in the eastern part of the country, among the asthmatic children of 4-12 years age group, the most common inhalant allergens were house dust mite and cockroach, whereas the common food allergens identified were milk and milk products, egg and egg products, and mustard.

New allergen sensitization might be associated with increased body mass index in children.

Results of previous studies have shown a relationship between obesity and allergic diseases. However, concrete evidence about the association between obesity and allergies has been lacking. The present study aimed to evaluate the potential association between body mass index (BMI) and the change in sensitization on skin-prick tests in children over a 2-year follow-up period. Children in first and second grade from six elementary schools were recruited in 2010. The same participants, now in third and fourth grade, were recruited again in 2012. The enrolled children underwent skin-prick tests and physical examinations in 2010 and again in 2012. Four hundred fourteen children (boys to girls, 208 to 206) were included. Among 414 participants, 73 children showed new sensitization and 24 children showed negative conversion of allergic sensitization after 2 years. One hundred sixty-one children showed positive results on both tests, and 156 children showed negative results on both tests. The mean (standard deviation) change in BMI (1.09 ± 1.81 kg/m(2)) over a 2-year follow-up in newly sensitized children was significantly greater than that of other groups (p = 0.008). Children who became newly sensitized to allergens tended to exhibit significant increases in BMI. Therefore, further evaluation of the relationship between obesity and allergy is needed.

Early House Dust Mite Sensitivity in Mumbai Children.

To identify house dust mite (HDM) sensitivity by skin prick test in children with allergic rhinitis, allergic wheezing and eczema. In this prospective study, children with persistent or recurrent allergic symptoms of rhinitis, wheezing and eczema were enrolled to undergo skin prick testing. Sensitivity was checked for three mites: Dermatophagoide farinae, Dermatophagoide pteronyssinus, and Blomia tropicalis. Total 92 children underwent skin prick test; 49 (53.2%) showed significant positivity to one or more dust mite. In the HDM sensitized group, a positive family history of allergic disorders was present in 32 children (65.3%). In the HDM sensitized group, 18 (36.7%) children had allergic rhinitis. The youngest child in this group was 12-mo-old. Ten (55.55%) children were less than 24mo of age. Significant sensitization to mites was detected in 7 (14.28%) children with eczema. All children were below 24 mo of age. In children with a tendency to wheeze frequently without any evidence of infections or other systemic disease, 24 (48.9%) had sensitization to HDM. The youngest child was 15 mo of age. Ten (41.6%) children were below 24 mo of age. Sensitivity to Blomia tropicalis was detected in 6 (12.24%) children. Significantly more number of children were sensitive to D. pteronyssinus as compared to D. farinae (65.31% vs. 46.94%; p = 0.034). Children in Mumbai show early sensitization to HDM. D. pteronyssinus is the commonest offending allergen in the index study.

Evaluation of children with steroid-sensitive nephrotic syndrome in terms of allergies

Background: The etiology of minimal-change disease is not fully known, it is believed to be mediated by the immune system. Minimal-change disease also reported as having association with atopy. In this study, atopy history, the levels of serum IgE, and skin prick test in children with steroid-sensitive nephrotic syndrome were investigated. Methods: A group of 30 children (mean age 7.7 ± 2.2 years, 56.6% male) diagnosed with steroid-sensitive nephrotic syndrome were included in the study. Serum immunoglobulin E levels and eosinophil counts were evaluated in children with steroid-sensitive nephrotic syndrome both in relapse and remission. Skin prick test was performed in remission. Results: Of the 30 children investigated, 11 (36.7%) had a history of atopy. The median serum total IgE levels in nephrotic children in relapse, with (445 IU/mL) and without atopy (310 IU/mL) were significantly higher than those in remission (respectively, 200 IU/mL, p = 0.021, and 42 IU/mL, p = 0.001). The skin prick tests for all the allergens were evaluated as negative in all the patients. Conclusion: It was thought that increased IgE may reflect the activation of immune mechanism following various stimuli rather than a direct association with atopy in children with steroid-sensitive nephrotic syndrome.

Investigation of the positivity profile for the skin prick test in children infected with parasites in the metropolitan region of Pernambuco, Northeast of Brazil

Methods Children between 2 and 14 year old were submitted to a parasitological survey using the Hoffman, Pons e Janer (3 blades) method and the Kato-Katz (2 blades) method. The ISAAC questionnaire was applied to collect informations related to asthma. The Skin Prick Test was applied using extracts of Dermatophagoides pteronyssinus (DP), Blomia tropicalis (BT), Blatella germânica (BG), Periplaneta americana (PA), fungus and cat epithelium (EPC).

The correlation between allergy sensitization rate in pediatric and aerobiological study for airborne pollen in Busan for 15 years

Purpose: Airborne pollen is the most common causative agents of allergic disease. Since 2000, there isn``t no more report about airborne pollen in Busan. This study is that pollen in one area of Busan was collected to investigate species, particle counts, seasonal distribution, and of its correlation with reactivity to skin prick test in children during 1998-2012. Methods: Rotorod sampler was installed on the rooftop of St. Mary Hospital in Busan. A 24-hour sampling of airborne allergens over a fifteen-year period was conducted 6 days/wk from January 1, 1998 to December 31, 2012. After staining they were identified, counted and recorded with the weather in Busan. Results: Major pollens collected were Pine, Alder, Oak, Juniperus, Humulus. The pollen season is relatively short and the pollen dispersed mainly during the period from March to May in case of tree pollen, from April to September in case of grass pollen and from August to October in case of weed pollen. Total annual pollen count ranged from 36,412 grains/m3 (2002) to 1,342 grains/m3 (2006). The peak pollen season was seen for spring and autumn, especially in May and September during 1998-2012. In skin prick tests, birch was the highest sensitization rate (15.1%), followed by alder (14.7%), hazel (14.1%) in the tree for 15 years. And in weed, mugwort and ragweed were the highest sensitization rate (10.6%, 10.3%), followed by humulus (5.5%) for 15 years, but since 2008, was increased. Conclusion: Analysis of pollens sampled in the atmosphere of Busan, Korea, for a 15-year period identified 24 species of pollens with seasonal variation of some clinically important pollen load. Analysis of data, it showed that alder and birch are main allergen in spring for 15 years, and in 1998-2008, ragweed and artemisia was main allergen in fall, since 2009, followed by humulus. (Allergy Asthma Respir Dis 2014;2:38-47)

Aeroalergen distribution in skin prick test in children who were diagnosed with asthma and allergic rhinitis in Malatya region.

Aeroalergen distribution in skin prick test in children who were diagnosed with asthma and allergic rhinitis in Malatya region.

Frequent Baked Egg Ingestion Was Not Associated With Change in Rate of Decline in Egg Skin-Prick Test in Children With Challenge-Confirmed Egg Allergy

To determine if the natural history of egg allergy would be altered by the frequent ingestion of baked egg in food challenge–confirmed egg-allergic children.A retrospective clinical cohort study of 125 children from the Department of Allergy and Immunology, Royal Children’s Hospital, Victoria, Australia, was completed. Participants from 1996 to 2005 with challenge-proven egg allergy were included, providing they had at least 2 egg skin-prick tests performed within this period.A telephone questionnaire was conducted to assess the frequency of baked egg ingestion as follows: (1) frequent (more than once per week), (2) regular (more than once every 3 months, up to once per week or less), or (3) strict avoidance (once every 3 months or less). A multiple linear regression analysis, adjusting for possible confounders, was used to examine the relationship between frequency of baked egg ingestion and the rate of decline in egg skin-prick test size.The mean rate of decline in egg skin-prick test size in all children was 0.7 mm per year (95% confidence interval [CI] 0.5–1.0 mm per year). The frequency of baked egg ingestion did not affect the rate of decline in egg skin-prick test size (P = .57). Individual results for each group were as follows: frequent ingestion (n = 21, mean 0.4 mm per year, 95% CI 0.3–1.2 mm per year), regular ingestion (n = 37, mean 0.9 mm per year, 95% CI 0.4–1.4 mm per year), and strict avoidance (n = 67, mean 0.7 mm per year, 95% CI 0.4–1.1 mm per year).Frequent baked egg ingestion was not associated with a different rate of decline in egg skin-prick test compared with strict avoidance in egg-allergic children.This study is different from previous studies from the Mount Sinai, New York, group (J Allergy Clin Immunol. 2008;122;977–983; J Allergy Clin Immunol. 2012;130(2):473–480) who have shown that regular ingestion of heated egg (defined as 1–3 servings per day) was associated with decreased skin-prick test wheal diameters to egg white and decreasing egg white, ovalbumin, and ovomucoid-specific immunoglobulin E antibody levels. This study does not specify the frequency of baked egg ingestion in the more than once a week group. It appears that this dosing interval may be critical to make the most impact immunologically. Clearly, ingestion once every 3 months or strict avoidance of egg does not appear to accelerate the development of egg tolerance.

Frequent baked egg ingestion was not associated with change in rate of decline in egg skin prick test in children with challenge confirmed egg allergy

It is controversial whether egg-allergic children should strictly avoid all forms of egg, or if regular ingestion of baked egg will either delay or hasten the resolution of egg allergy. This is the first study to examine the relationship between frequency of baked egg ingestion and rate of decline in egg skin prick test size in egg-allergic children. This was a retrospective clinical cohort study. All children with challenge-proven egg allergy who attended the Royal Children's Hospital Allergy Department 1996-2005 and had at least two egg skin prick tests performed in this period were included (n = 125). Frequency of baked egg ingestion was assessed by telephone questionnaire as follows: (a) frequent (> once per week), (b) regular (> once every 3 months, up to ≤ once per week) or (c) strict avoidance (≤ once every 3 months). The relationship between frequency of baked egg ingestion and rate of decline in egg skin prick test size was examined by multiple linear regression, adjusting for potential confounders. Mean rate of decline in egg skin prick test size in all children was 0.7 mm/year (95% CI 0.5-1.0 mm/year). There was no evidence (P = 0.57) that the rate of decline in egg skin prick test size differed between children who undertook frequent ingestion (n = 21, mean 0.4 mm/year, 95% CI -0.3-1.2 mm/year), regular ingestion (n = 37, mean 0.9 mm/year, 95% CI 0.4-1.4 mm/year) or strict avoidance (n = 67, mean 0.7 mm/year, 95% CI 0.4-1.1 mm/year) of baked egg. Compared with strict dietary avoidance, frequent consumption of baked egg was not associated with a different rate of decline in egg skin prick test size in egg-allergic children. Given that dietary restrictions can adversely impact on the family, it is reasonable to consider liberalizing baked egg in the diet of egg-allergic children.

Skin prick test and specific serum IgE in the diagnostic evaluation of suspected cow's milk and hen's egg allergy in children: does one replace the other?

The measurement of specific serum immunoglobulin E (sIgE) and the skin prick test (SPT) are accepted tools in the diagnostic work-up of suspected food allergy. Often only one of the methods is used to determine sensitization; however, it is still under debate whether these two methods can be used interchangeably. To investigate the concordance of SPT and sIgE serum assays with regard to suspected food allergy. In 395 children referred to our clinic with suspected cow's milk allergy and in 268 children with suspected hen's egg allergy specific immunoglobulin E (IgE) was measured, a SPT and an oral food challenge performed. A weal size≥3mm and sIgE≥0.35 kU/L were considered positive. The weal size of the SPT and the level of food-specific IgE were tested for correlation for each allergen. Of the 395 (23%) children orally challenged with cow's milk, 92 showed no corresponding results for SPT and sIgE as either positive or negative. For hen's egg, in 27 of 268 (10%) children differing test results for SPT and sIgE in serum were obtained. Moreover, regarding the quantitative values for sIgE and SPT in children with or without clinically relevant food allergy, sIgE and SPT correlated badly. The concordance between SPT and sIgE is surprisingly low for cow's milk and hen's egg on an individual basis. Therefore, the tests should not be used interchangeably. Especially in children who receive a negative test result the alternative test should also be used. Furthermore, our data indicate again that oral food challenges are still the method of choice to diagnose food allergies.

Usefulness of Skin-Prick Tests in Children With Hand Eczema: Comparison With Their Use in Childhood and Adult Eczema

Background Hand eczema is not uncommon in children but it is rarely studied using skin-prick tests. Few reports have addressed their usefulness in children and none has specifically analyzed their use in children with hand eczema. Material and methods We performed a retrospective study of all children up to 16 years of age with hand eczema who were assessed in the Department of Dermatology at Hospital General Universitario in Alicante, Spain with the standard GEIDAC panel over a 5-year period. We compared the epidemiologic data and results of skin-prick tests in this group with those obtained in children with eczema at any site and in adults with hand eczema. Results The study included a total of 1695 patients: 141 (8.3%) children and 1533 (91.7%) adults. Hand eczema was diagnosed in 496 (31.9%) adults and 32 (22.7%) children. Positive results were obtained in skin-prick tests in 50% of children with hand eczema compared with 37.6% of children with eczema at any site and 50.6% of adults with hand eczema. The current relevance of the positive allergens found in children with hand eczema (76.2%) was greater than that observed in children with eczema at any site (61%) or in adults with hand eczema (43%). The most common allergens in children with hand eczema were kathon CG and fragrance mix I, whereas in the other 2 groups metals were the most common. The most common final diagnosis in children with hand eczema was allergic contact dermatitis (34.3%), which proved to be more common than atopic dermatitis. Conclusions We recommend the use of skin-prick tests in all children with chronic hand eczema.

Shellfish allergy in children

Food allergies affect approximately 3.5-4.0% of the world's population and can range from a mere inconvenience to a life-threatening condition. Over 90% of food allergies in childhood are caused by eight foods: cow's milk, hen's egg, soy, peanuts, tree nuts, wheat, fish, and shellfish. Shellfish allergy is known to be common and persistent in adults, and is an important cause of food induced anaphylaxis around the world for both children and adults. Most shellfish-allergic children have sensitivity to dust mite and cockroach allergens. Diagnostic cut-off levels for skin prick testing in children with shrimp allergy exist but there are no diagnostic serum-specific immunoglobulin E (IgE) values. All patients with symptoms of IgE-mediated reactions to shellfish should receive epinephrine autoinjectors, even if the initial symptoms are mild. In this study, we review three cases of clinical presentations of shellfish allergy in children.