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Vol. 48. Issue 4.
Pages 323-331 (July - August 2020)
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Vol. 48. Issue 4.
Pages 323-331 (July - August 2020)
Original Article
DOI: 10.1016/j.aller.2020.03.002
Atopy patch test in children with cow's milk and hen's egg allergy: Do clinical symptoms matter?
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S. Sirin Kose
Corresponding author
sedasirin85@yahoo.com

Corresponding author.
, S. Asilsoy, D. Tezcan, G. Atakul, S. Al, O. Atay, O. Kangalli Boyacioglu, N. Uzuner, O. Anal, O. Karaman
Dokuz Eylul University, Division of Pediatric Immunology and Allergy, Izmir, Turkey
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Tables (5)
Table 1. Demographic, clinical and laboratory data of patients with suspected CMA, HEA and the overall study group.
Table 2. Demographic, clinical and laboratory data of patients with suspected CMA and HEA in terms of positive and negative APT.
Table 3. Demographic, clinical and laboratory data of patients with positive OFC for cow's milk or hen's egg in terms of positive and negative APT.
Table 4. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of sIgE, skin prick test, and atopy patch test compared with OFC in cow's milk allergy.
Table 5. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of sIgE, skin prick test and atopy patch test compared with OFC in hen's egg allergy.
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Abstract
Introduction and objectives

Since early 2000s, atopy patch test (APT) has been used to determine non-IgE and mixed-type food allergies. Previous studies have reported conflicting results about the diagnostic value of APT in food allergies, due to non-standardized methods.

We aimed to determine the diagnostic efficacy of APT compared to open oral food challenge (OFC) in patients diagnosed with cow's milk allergy (CMA) and hen's egg allergy (HEA) manifesting as atopic dermatitis (AD) and gastrointestinal system symptoms.

Materials and methods

In patients with suspected AD and/or gastrointestinal manifestations due to CMA and HEA, the results of OFC, APT, skin prick test (SPT) and specific IgE (sIgE) were reviewed. Specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of sIgE, SPT, APT and SPT+APT were calculated.

Results

In total 133 patients with suspected CMA (80) and HEA (53) were included in the study.

In patients with CMA presenting with gastrointestinal symptoms, APT had sensitivity of 9.1%, specificity of 100%, PPV of 100% and NPV of 48.7%. In atopic dermatitis patients, sensitivity of APT was 71.4%, specificity 90.6%, PPV 62.5% and NPV 93.6%.

In patients diagnosed with HEA, the sensitivity, specificity, PPV and NPV values of APT were 72.0%, 78.6%, 47.2% and 75.0%, respectively. In patients diagnosed with HEA presenting with AD, sensitivity of APT was 87.5%, specificity 70.6%, PPV 73.7% and NPV 85.7%. Atopy patch test had lower sensitivity (44.4%) and higher specificity (90.9%) in patients diagnosed with HEA presenting with gastrointestinal symptoms than those presenting with AD.

Conclusion

Our study showed that APT provided reliable diagnostic accuracy in atopic dermatitis patients. However, APT had low sensitivity in patients with gastrointestinal symptoms.

Keywords:
Atopy patch test
Cow's milk allergy
Hen's egg allergy
Children

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