Immediate contact reactions to cow's milk and egg in atopic children.

Forty children (0-5 years old), presented with immediate contact urticaria, rash and often atopic dermatitis (n = 34). Redness or urticaria around the mouth appearing after consuming cow's milk or egg, were the major complaints in all. These symptoms suggested a food-induced immediate contact reaction, which can be immune-mediated or irritative. To reinduce this reaction, a skin provocation test, called SAFT, was performed. SAFT stands for Skin Application Food Test. This test is based on direct skin contact, during a maximum of 30 min with food in its 'ordinary consumptive state'. The SAFT can be regarded as a 'physiological' provocation patch test. If positive, contact urticaria develops most often within a few minutes. The results of SAFT and IgE RAST correlated significantly well. Total IgE values were not informative. The rapid onset of the SAFT reaction, induced by proteins, supported by RAST results, strongly indicates an immune-mediated mechanism. In 52% of the 34 patients with atopic dermatitis, dermatitis was exacerbated following food-to-skin contact. Immune-mediated contact reactions to foods play an important role in (dermal) food allergy.