Roehr C C, Reibel S, Ziegert M, Sommerfeld C, Wahn U, Niggemann B
Department of Pneumology and Immunology, University Children's Hospital Charité of Humboldt University, Berlin, Germany.
J Allergy Clin Immunol. 2001 Mar;107(3):548-53. doi: 10.1067/mai.2001.112849.
Atopic dermatitis is commonly associated with food allergy. In addition to skin prick tests (SPTs) and measurements of specific IgE levels, the atopy patch test (APT) has recently been introduced into the diagnostic procedure for food allergy.
Our aim was to evaluate whether a combination of allergologic tests could improve the prognostic value of the individual tests for positive food challenge results. We hypothesized that the combination of a positive APT result plus proof of specific IgE, a positive SPT result, or both would render double-blind, placebo-controlled, food challenges unnecessary.
One hundred seventy-three double-blind, placebo-controlled, food challenges were performed in 98 children (median age, 13 months) with atopic dermatitis. All children were subjected to SPTs, APTs, and determination of specific IgE. Sensitivity, specificity, and positive and negative predictive values were calculated.
Ninety-five (55%) of 173 oral provocations were assessed as positive. For evaluating suspected cow's milk (CM) allergy, the APT was the best single predictive test (positive predictive value [PPV], 95%), and the combination of a positive APT result with evidence of specific IgE or an APT result together with a positive skin prick test response optimized the PPV to 100%. For hen's egg (HE) allergy, the APT was also the best single predictive test (PPV, 94%). The combination of 2 or more tests did not exceed the APT's predictive value. In both CM and HE challenges, the predictability of oral challenges depended on the level of specific IgE. For wheat allergy, the APT proved to be the most reliable test, and the PPV of 94% could not be improved by a combination with other allergologic tests.
The combination of positive APT results and measurement of levels of specific IgE (CM, > or = 0.35 kU/L; HE, > or = 17.5 kU/L) makes double-blind, placebo-controlled, food challenges superfluous for suspected CM and HE allergy.
特应性皮炎通常与食物过敏相关。除了皮肤点刺试验（SPT）和特异性IgE水平检测外，特应性斑贴试验（APT）最近已被引入食物过敏的诊断程序中。
我们的目的是评估多种变应性检测方法的联合应用是否能提高个体检测方法对食物激发试验阳性结果的预测价值。我们假设APT结果阳性加上特异性IgE检测阳性、SPT结果阳性或两者皆有，将使双盲、安慰剂对照的食物激发试验不再必要。
对98名（中位年龄13个月）患有特应性皮炎的儿童进行了173次双盲、安慰剂对照的食物激发试验。所有儿童均接受了SPT、APT和特异性IgE检测。计算了敏感性、特异性以及阳性和阴性预测值。
173次口服激发试验中有95次（55%）被评估为阳性。对于评估疑似牛奶（CM）过敏，APT是最佳的单项预测检测方法（阳性预测值[PPV]，95%），APT结果阳性与特异性IgE证据相结合或APT结果与皮肤点刺试验阳性反应相结合可将PPV优化至100%。对于鸡蛋（HE）过敏，APT也是最佳的单项预测检测方法（PPV，94%）。两种或更多检测方法的联合应用并未超过APT的预测价值。在CM和HE激发试验中，口服激发试验的可预测性取决于特异性IgE水平。对于小麦过敏，APT被证明是最可靠的检测方法，与其他变应性检测方法联合应用无法将94%的PPV进一步提高。
对于疑似CM和HE过敏，APT结果阳性与特异性IgE水平检测（CM，≥0.35 kU/L；HE，≥17.5 kU/L）相结合使得双盲、安慰剂对照的食物激发试验不再必要。
