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Inicio Allergologia et Immunopathologia Low efficacy of atopy patch test in predicting tolerance development in non-IgE-...
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Vol. 46. Issue 3.
Pages 241-246 (May - June 2018)
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Vol. 46. Issue 3.
Pages 241-246 (May - June 2018)
Original Article
DOI: 10.1016/j.aller.2017.07.001
Low efficacy of atopy patch test in predicting tolerance development in non-IgE-mediated cow's milk allergy
T.A. Gonzaga, F.A. Alves, M.F.A. Cheik, C.P. de Barros, E.R.M.A. Rezende, G.R.S. Segundo
Corresponding author

Corresponding author.
Food Allergy Research Group, Pediatrics Department, Universidade Federal de Uberlandia, Brazil
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Figures (1)
Tables (3)
Table 1. Clinical features of patients with positive and negative cow's milk oral food challenge (OFC).
Table 2. Oral food challenge (OFC) positive challenge patients features.
Table 3. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of cow's milk atopy patch test compared with oral food challenge.
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The food atopy patch (APT) test has been used in previous studies to help the diagnosis of non-IgE mediated food allergies (FA). The aim of this study was to evaluate the efficacy of different cow's milk APT preparations to predict oral tolerance in children with previous non-IgE-mediated cow's milk allergy (CMA) diagnosis.


Thirty-two patients non-IgE-mediated CMA diagnosed by oral food challenge (OFC) were enrolled to perform APT with three different cow's milk preparations (fresh, 2% in saline solution, 2% in petrolatum) and comparing with a new OFC after at least three months of diet exclusion.


Only six (18.7%) subjects presented positive OFC to cow's milk. No differences in gender, onset symptoms age, OFC age, Z-score, and exclusion period were found between positive and negative OFC patients. Preparations using fresh milk and powdered milk in petrolatum presented sensitivity equal to zero and specificity 92.3% and 96.1%. The preparation using powdered milk in saline solution showed sensitivity and specificity of 33.3% and 96.1%. Two patients presented typical IgE symptoms after OFC.


Cow's milk APT presented a low efficacy to predict tolerance in patients with previous non-IgE-mediated CMA and should not be used in clinical routine. The presence of typical IgE reactions after OFC hallmark the necessity of previous IgE-mediated investigation for this patient group.

Cow's milk allergy
Atopy patch test
Non-IgE-mediated food allergy


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