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

Abstract

Background: Atopic dermatitis (AD) is frequently associated with food allergies. In addition to the skin prick test (SPT) and serum-specific IgE, the atopy patch test (APT) has been introduced as a diagnostic procedure for food allergies. Objective: Our aim was to evaluate the diagnostic value of the APT, the SPT and the serum-specific IgE levels compared with that of oral food challenge test against milk and egg in AD patients. Methods: We conducted the SPT and APT, and determined the serum-specific IgE levels against milk and egg antigens for 101 patients. Oral food challenge tests were conducted for 86 out of 101 AD patients. The sensitivity, specificity and positive and negative predictable values were calculated for all the tests. Results: Twenty-five patients were positive to oral food challenges. The sensitivity of the APT for milk was 66.7%, while the figures for the SPT and the serum-specific IgE were 35.5% and 14.2%. The sensitivity of the APT for egg was 50%, while that for the SPT and serum-specific IgE were 21.4% and 6.7%. Conclusion: We were able to conclude that the APT test seems to be a valuable additional tool for the diagnostic method of food allergies in AD. (Ann Dermatol 22(4) 404∼411, 2010)

Diagnostic accuracy of patch test in children with food allergy

“…There were conflicting results in the previous literature regarding the use of APT for the diagnosis of food allergies (Table 5). In agreement with previous studies (8)(9)(10)(11)(12)(19)(20)(21)(22)(23), we found that sensitivity to egg and cow's milk was low. On the other hand, our results showed remarkably lower specificity (73%) for APT in comparison with the previous studies (8,9,11,19,20,23).…”

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

“…After reviewing the full‐text, 40 articles were removed including 4 studies of which we were unable to find the full‐text. Finally, of the remaining 45 candidate articles, 4 studies were removed because the data we calculated based on the provided data were inconsistent with the information mentioned in the articles. We contacted the authors and no response was received.…”

The skin prick test – European standards

“…For example, SPT is not practical in patients who have extensive eczema, dermographism, urticaria, or who are taking antihistamines or other medications which interfere with the proper interpretation of the test results (Table 2). In vitro test methods may be less sensitive [11,12] and/or less specific [13,14] than SPT depending on the method utilized and the allergens employed. Furthermore, in subjects with very high total serum IgE antibodies, low levels of specific IgE antibodies of doubtful clinical relevance are often detected.…”