Significance of Atopic Patch Tests and Other Diagnostic Methods in the Diagnostics of Food Allergy to Cow’s Milk and Wheat Flour in Patients with Atopic Eczema Older Than 14 Years
Authors:
J. Čelakovská 1; K. Ettlerová 2; K. Ettler 1; J. Vaněčková 1; J. Bukač 3
Authors place of work:
Klinika nemocí kožních a pohlavních FN a LF UK Hradec Králové
přednosta doc. MUDr. Karel Ettler, CSc.
1; Ambulance klinické imunologie a alergologie, Hradec Králové
vedoucí MUDr. Květuše Ettlerová
2; Ústav lékařské biofyziky LF UK Hradec Králové, přednosta doc. Ing. Josef Hanuš, CSc.
3
Published in the journal:
Čes-slov Derm, 84, 2009, No. 5, p. 254-263
Category:
Clinical and laboratory Research
Summary
The significance of food allergy in children with atopic eczema, especially those younger than 3 years was confirmed by extensive studies. On the contrary, extensive study of food allergy in adults with atopic eczema is not available.
The aim of our study
was to evaluate the importance of atopy patch test and other diagnostic methods in the diagnostics of food allergy in patients with atopic eczema older than 14 years in comparison with double-blind, placebo-controlled food challenge – a gold standard in the diagnostics of food allergy.
Results showed food allergy to cow’s milk and wheat flour in one patient at the same time and to wheat flour in four patients of 149 patients. During one year of elimination diet the important improvement of skin involvement was observed.
This pilot study proved that the double-blind, placebo-controlled food challenge is the most important for the diagnosis of food allergy. Regarding cow’s milk, relation between skin prick tests positivity with confirmed food allergy was found, on the contrary, wheat showed relation between specific IgE positivity with confirmed food allergy, only. Atopy patch tests were not helpful in diagnosis of this type of food allergy and, in our opinion, are not suitable, as separated tests, for the determination of food allergy in adult patients with moderate to severe atopic eczema. Oral food challenge test and double-blind, placebo-controlled food challenge may help to prevent unnecessary restrictive diets based on inproper diagnostics.
Key words:
atopic eczema – atopy patch test – food allergy
Zdroje
1. ABERNATHY-CARVER, KJ., SAMPSON, HA., et al. Milk-induced eczema is associated with the expansion of T cells expressing cutaneous lymphocyte antigen. J Allergy Clin Immunol, 2002; 109, p. 688-693.
2. ATHERTON, DJ., SEWELL, M., SOOTHILL, JF., WELLS, S. A double-blind controlled crossover trial of an antigen-avoidance diet in atopic eczema. Lancet, 1978, 1, p. 401-403.
3. BINDSLEV-JENSEN, C., BALLMER–WEBER, BK., BENGTSSON, U., et al. Standardization of food challenges in patients with immediate reactions to foods – position paper from the European Academy of Allergology and Clinical Immunology. Allergy, 2004, 59, p. 690-697.
4. BINDSLEV-JENSEN, C. Standardization of double-blind, placebo-controlled food challenges. Allergy, 2001, 56 Suppl 67:S 83-5.
5. BOCK, SA. Food challenges in the diagnosis of food hypersensitivity In: De Weck AL, Sampson HA, editors. Intestinal immunology and food allergy. New York: Raven Press; 1995, p. 105-17.
6. BEYER, K., TEUBER, SS. Food allergy diagnostics: scientific and unproven procedures. Current Opinion in Allergy and Clinical Immunology, 2005, 5, p. 261-266.
7. BREUER, K., HERATIZADEH, A., WULF, A., et al. Late eczematous reactions to food in children with atopic dermatitis. Clin Exp Allergy, 2004, 34, p. 817- 824.
8. BURKS, AW. Skin manifestations of food allergy. Pediatrics, 2003, 111, p. 1617- 1624.
9. CELIK-BILGILI, S., MEHL, A., VERSTEGE, A., STADEN, U., NOCON, M., BEYER, K., NIGGEMANN, B. The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges. Clin Exp Allergy, 35, 2005, p. 268-273.
10. DARSOW, U., LAIFAOUI, J., KERSCHENLOHR, K., WOLLENBERG, A., PRZYBILLA, B., WÜTHRICH, B., BORELLI, S., GIUSTI, F., SEIDENARI, S., DRZIMALLA, K., SIMON, D., DISCH, R. The prevalence of positive reactions in the atopy patch test with aeroallergen and food allergens in subjects with atopic eczema: a European multicenter study. Allergy, 2004, 59, 12, p. 1318-1325.
11. ETTLER, K. Indexy v klinickém hodnocení psoriázy a atopického ekzému. Čs. Derm, 1995, 70, 1, p. 45-47.
12. HAMMAR, N. Provocation with cow’s milk and cereals in atopic dermatitis. Acta Derm Venereol, 1977, 57, p. 159-163.
13. HEINE, RG., VERSTEGE, A., MEHL, A., STADEN, U., ROLINCK-WERNINGHAUS, C., NIGGEMANN, B. Proposal for a standardized interpretation of the atopy patch test in children with atopic dermatitis and suspected food allergy. Pediatr Allergy Immunol, 2006, 17, p. 213-217.
14. KALACH, N., SOULAINES, P., DE BOISSIEU, D., DUPONT, C. A pilot study of the usefulness and safety of a ready-to-use atopy patch test (Diallertest) versus a comparator (Finn chamber) during cow ´s milk allergy in children. J Allergy Clin Immunol, 2005, 116, p. 1321-1326.
15. MEHL, A., ROLINCK –WERNINGHAUS, C., STADEN, U. The atopy patch test in the diagnostic work-up of suspected food related symptoms in children. J Allergy Clin Immunol, 2006, 118, p. 923-929.
16. METCALFE, DD., SAMPSON, HA. Workshop on experimental methodology for clinical studies of adverse reactions to foods and food additives. J. Allergy Clin. Immunol, 1990, 86, p. 421-442.
17. NIGGEMANN, B., ROLINCK-WEMINGHAUS, C., MEHL, A., BINDER, C., ZIEGERT, M., BEYER, K. Controlled oral food challenges in children – when indicated, when superfluous? Allergy, 2005, 60 (7), p. 865.
18. NIGGEMANN, B., SIELAFF, B., BEYER, K., et al. Outcome of double-blind, placebo-controlled food challenge tests in 107 children with atopic dermatitis. Clin Exp Allergy, 1999, 29, p. 91-96.
19. NIGGEMANN, B. Role of oral food challenges in the diagnostic work-up of food allergy in atopic eczema dermatitis syndrome. Allergy, 2004, 59 (Suppl 78), p. 32-34.
20. NIGGEMANN, B., ZIEGERT, M., REIBEL, S. : Importance of chamber size for the outcome of atopy patch testing in children with atopic dermatitis and food allergy. J Allergy Clin Immunol, 2002, 110, p. 515-516.
21. NIGGEMANN, B., REIBEL, S., WAHN, U.: The atopy patch test( APT) – a useful tool for the diagnosis of food allergy in children with atopic dermatitis. Allergy, 2000, 55, p. 281-285.
22. ORTOLANI, C., ISPANO, M. Foods and chronic urticaria. Clin. Rev. Allergy, 1992, 10, p. 325-347.
23. REEKERS, R., BUSCHE, M., WITTMANN, M., KAPP, A., WERFEL, T. Birch pollen-related foods triger atopic dermatitis in patients with specific cutaneous T-cell responses to birch pollen antigens. J Allergy Clin Immunol, 104, 1999, p. 466-472.
24. ROEHR, CH. C., REIBEL, S., ZIEGERT, M., SOMMERFELD, CH., WAHN, U., NIGGEMANN, B. Atopy patch tests, together with determination of specific IgE levels, reduce the need for oral food challenges in children with atopic dermatitis. J. Allergy Clin Immunol, 2001, 107, p. 548-553.
25. ROGER, A., PENA, M., BOTEY, J., ESEVERRI, JL., MARIN, A. The prick test and specific IgE (RAST and MAST-CLA) compared with the oral challenge test with milk, eggs and nuts. J. Invest Allergol Clin Immunol, 1994, 4, p. 178-181.
26. SAARINEN, KM., SUOMALAINEN, H., SAVILATHI, E. Diagnostic value of skin prick and patch tests and serum eosinophil cationic protein and cow’s milk specific IgE in infants with cow’s milk allergy. Clin Exp Allergy, 2001, 31, p. 423-429.
27. SAMPSON, HA. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol, 1997, 100, p. 444-451.
28. SAMPSON, HA. Update on food allergy. J Allergy Clin Immunol, 2004, 113, p. 5.
29. ŠPIČÁK, V., PANZNER, P. Alergologie. Praha, Galén, 2004, 1. vyd., ISBN 80-7262-265-X.
30. WERFEL, T., AHLERS, G., SCHMIDT P. et al. Milk-responsive atopic dermatitis is associated with a casein-specific lymphocyte response in adolescent and adult patients. J Allergy Clin Immunol, 1997, 99, p. 124-133.
31. WERFEL, T., BREUER, K. Role of food allergy in atopic dermatitis. Curr Opin Allergy Clin Immunol, 2004, 4, p. 379-385.
32. WERFEL, T., BALLMER-WEBER, B., EIGENMANN, P.A., NIGGEMANN, B., RANCÉ, F., TURJANMAA, K., WORM, M. Eczematous reactions to food in atopic eczema: position paper of the EAACI and GA2LEN, Allergy, 2007, 62, p. 723-728.
33. WORM, M., FORSCHNER, K., LEE, H., ROEHR, C., EDENHARTER, G., NIGGEMANN, B. et al. Frequency of atopic dermatitis and relevance of food allergy in adults in Germany. Acta Derm Venereol, 2006, 86, p. 119-122.
34. WÜTHRICH, B. Food-induced cutaneous adverse reactions. Allergy, 1998, 53 (Suppl), p. 131-135.
Štítky
Dermatology & STDs Paediatric dermatology & STDsČlánok vyšiel v časopise
Czech-Slovak Dermatology
2009 Číslo 5
Najčítanejšie v tomto čísle
- Syphilis and HIV Coinfection
- Primary Cutaneous Actinomycosis in Two Patients Treated with Clindamycin
- Cutaneons Metastasis as a Primary Manifestation of a Renal Cell Carcinoma
- Diabetic Foot Syndrome – a Diabetologist’s View