Combined skin prick and patch testing enhances identification of food allergy in infants with atopic dermatitis,☆☆,,★★

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Abstract

BACKGROUND: Early recognition of dietary allergies in infants with atopic dermatitis is essential for avoidance of unnecessary elimination diets, amelioration of the skin disease, and secondary prevention of the development of multiple food allergies. Simple and accurate methods of identifying provocative foods are urgently needed. METHODS: The usefulness of skin prick and patch tests as indicators of cow milk allergy was evaluated in 183 patients ranging in age from 2 to 36 months with double-blind, placebo-controlled (n = 118) or open (n = 65) cow milk challenges. RESULTS: The oral cow milk challenges were interpreted as positive in 54% of both challenge types. Positive challenge rapidly elicited pruritus, urticaria, and/or exanthema in 49% of cases and delayed-onset eczematous lesions in 51%. The skin prick and patch tests gave markedly discrepant results; prick tests were positive in 67% of the cases with acute-onset reactions to milk challenge, whereas patch tests tended to be negative. Patch tests were positive in 89% of those with delayed-onset reactions, although prick tests were frequently negative. CONCLUSIONS: The observations indicate that IgE and T cell-mediated responses to cow milk can be distinguished in atopic dermatitis. Parallel skin testing with combined prick and patch tests can significantly enhance the accuracy in diagnosis of specific dietary allergies in patients with atopic dermatitis. (J ALLERGY CLIN IMMUNOL 1996;97:9-15.)

Section snippets

Patients

The study comprised 183 children ranging in age from 2 to 36 months (mean 14 months) and fulfilling the Hanifin criteria15 of atopic dermatitis in children. They had been referred to a teaching pediatric or dermatologic clinic for evaluation of atopic dermatitis and were not selected on the basis of suspected allergy to cow milk. The mean age (95% confidence interval, [CI]) at onset of dermatitis was 4 months (95% CI, 3.5 to 5 months), and the duration of breast-feeding, exclusively and

RESULTS

Of the total 183 cow milk challenges, 99 (54%) gave results interpreted as positive. The mean (95% CI) age of the patients was 14 months (12 to 16 months) in the positive and 14 months (13 to 16 months) in the negative group; t = 0.24, p = 0.81. The mean serum IgE concentration was higher in the positive group than in the negative group, viz. 45 kU/L (95% CI, 30 to 67 kU/L) versus 23 kU/L (95% CI, 14 to 37 kU/L); t = 2.16, p = 0.03. Cow milk–specific IgE antibodies, RAST ≥0.4 kU/L, were

DISCUSSION

Atopic dermatitis is a common and complex, chronically relapsing skin disorder of infancy and childhood. Immunologically it is characterized by increased, mainly allergen-specific, IgE production. Because elevated specific IgE can be demonstrated by skin prick testing, these tests are widely used to disclose food allergy in patients with atopic dermatitis.7, 8, 9 The results in our study support previous findings that T cell-mediated reactions can be distinguished in atopic dermatitis18, 19, 20

Acknowledgements

We thank SHS Int. Ltd., Liverpool, U.K., for providing Neocate, and Valio Ltd., Helsinki, Finland, for providing the whey hydrolysate formula for this investigation.

References (27)

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From athe Medical School, University of Tampere and the Department of Pediatrics, and bthe Department of Dermatology, Tampere University Hospital.

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Supported by the Academy of Finland.

Reprint requests: Erika Isolauri, MD, Medical School, University of Tampere, P.O. Box 607, 33101 Tampere, Finland.

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