Boonyaviwat Onsuree, Pacharn Punchama, Jirapongsananuruk Orathai, Vichyanond Pakit, Visitsunthorn Nualanong
Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Pediatr Allergy Immunol. 2015 Dec;26(8):737-41. doi: 10.1111/pai.12382. Epub 2015 Jun 5.
Double-blind, placebo-controlled food challenge is the gold standard for diagnosing food allergy. However, it is a time-consuming procedure and requires onsite medical supervision and resuscitating medicines and devices on hand. The objective of this study was to compare the atopy patch test (APT) with the oral food challenge test (OFC) in children with suspected food allergy-related gastrointestinal (GI) symptoms.
A prospective self-controlled study enrolled children with a history of suspected food allergy-related GI symptoms. Skin prick test (SPT) and APT using lyophilized and commercial allergen extracts for cow's milk, egg, wheat, soy, and shrimp were evaluated, and OFC was performed.
Thirty-nine patients (25 boys, median age 2.4 yrs) with 76 events of suspected food allergy-related GI symptoms were enrolled. SPT was positive in 11/76 events (14.5%). Sensitivity, specificity, predictive values, and likelihood ratio were calculated related to the food challenge outcome. Of 41 OFC, 30 (73.2%) were positive. APT using lyophilized allergen extracts yielded high sensitivity (80%) and high positive predictive value (85.7%). APT using commercial allergen extracts yielded low sensitivity (30%) but high specificity (90%). The negative predictive value of APT using lyophilized and commercial allergen extracts was 53.8% and 32.2%, respectively. All cases with positive APT using lyophilized allergen extracts together with positive SPT also had positive OFC.
In contrast to commercial extracts, APT with lyophilized allergen extracts is reliable, safe, and maybe useful for the diagnosis of suspected food allergy-related GI symptoms in children. OFC is still needed in most of the cases.
双盲、安慰剂对照食物激发试验是诊断食物过敏的金标准。然而，这是一个耗时的过程，需要现场医疗监督以及随时可用的复苏药物和设备。本研究的目的是比较特应性斑贴试验（APT）与口服食物激发试验（OFC）在疑似食物过敏相关胃肠道（GI）症状儿童中的应用。
一项前瞻性自身对照研究纳入了有疑似食物过敏相关GI症状病史的儿童。评估了使用冻干和市售过敏原提取物对牛奶、鸡蛋、小麦、大豆和虾进行的皮肤点刺试验（SPT）和APT，并进行了OFC。
纳入了39例患者（25名男孩，中位年龄2.4岁），出现76次疑似食物过敏相关GI症状事件。在76次事件中，SPT阳性的有11次（14.5%）。计算了与食物激发试验结果相关的敏感性、特异性、预测值和似然比。在41次OFC中，30次（73.2%）为阳性。使用冻干过敏原提取物的APT具有高敏感性（80%）和高阳性预测值（85.7%）。使用市售过敏原提取物的APT敏感性低（30%）但特异性高（90%）。使用冻干和市售过敏原提取物的APT的阴性预测值分别为53.8%和32.2%。所有使用冻干过敏原提取物的APT阳性且SPT阳性的病例OFC也为阳性。
与市售提取物相比，使用冻干过敏原提取物的APT可靠、安全，可能有助于诊断儿童疑似食物过敏相关GI症状。大多数情况下仍需要OFC。
