Department of Pediatric Allergy Immunology, Tepecik Training and Research Hospital, Izmir, Turkey -
Department of Pediatric Allergy Immunology, Adnan Menderes University Medical Faculty, Aydın, Turkey.
Minerva Pediatr (Torino). 2022 Jun;74(3):318-324. doi: 10.23736/S2724-5276.16.04424-8. Epub 2016 Apr 15.
Atopic dermatitis (AD) is a chronic inflammatory skin disease. A third of pediatric AD patients have also food allergy. Although food challenge test is gold standard test for the diagnosis of food allergies, they should be administered by experienced physicians, considering that the test is time-consuming and carries some risks. Documentation of the efficacies of specific IgE (sIgE), skin prick test (SPT), and atopy patch test (APT) are important for determining the necessity of oral food challenge tests(OFC).
Fifty-three AD patients with suspected cow's milk allergy (CMA) were included in our study. Diet-related questions were asked to the patients. Blood samples were taken for measurement of total blood count, total IgE, and milk sIgE. OFC, SPT, and APT were performed using pasteurized cow milk.
The mean age of the study population was 1.4±0.8 years, and the male:female ratio was 1.12. Cow milk allergy was detected in 45.3% of the patients after OFC. A comparison between CMA(+) and CMA(-) patients revealed no significant difference in sIgE positivity (P=0.940), but there was a significant difference in SPT (P=0.000) and APT (P=0.001) positivity. When our study group was divided into immediate reaction, delayed onset reaction, and not reactive subgroups after OFC, efficacy of SPT was more prominent in immediate reaction subgroup while APT was more efficient in delayed reaction subgroup.
Our study showed that using SPT test with APT test in allergic reactions with IgE and other mechanisms such as AD will increase the diagnostic yield, thereby reducing the need for OFC.
特应性皮炎（AD）是一种慢性炎症性皮肤病。三分之一的儿科 AD 患者也有食物过敏。虽然食物挑战试验是诊断食物过敏的金标准试验，但由于试验耗时且存在一定风险，应由经验丰富的医生进行。记录特异性 IgE（sIgE）、皮肤点刺试验（SPT）和特应性皮炎斑贴试验（APT）的疗效对于确定口服食物挑战试验（OFC）的必要性非常重要。
我们纳入了 53 例疑似牛奶过敏（CMA）的 AD 患者。向患者询问与饮食相关的问题。采集血样以测量全血细胞计数、总 IgE 和牛奶 sIgE。使用巴氏消毒牛奶进行 OFC、SPT 和 APT。
研究人群的平均年龄为 1.4±0.8 岁，男女比例为 1.12。OFC 后 45.3%的患者检测出牛奶过敏。CMA(+)和 CMA(-)患者之间的比较显示 sIgE 阳性率无显著差异（P=0.940），但 SPT（P=0.000）和 APT（P=0.001）阳性率有显著差异。OFC 后将本研究组分为即刻反应、迟发反应和无反应亚组，SPT 在即刻反应亚组中的疗效更为显著，而 APT 在迟发反应亚组中的效果更为显著。
我们的研究表明，在 IgE 和其他机制（如 AD）引起的过敏反应中使用 SPT 试验和 APT 试验，将提高诊断率，从而减少 OFC 的需求。
