Document Type : Original Article
Authors
1 Department of Pediatrics, Afzalipoor Hospital, Kerman University of Medical Sciences, Kerman, Iran
2 Pediatrician, Depatment of Pediatrics, Jiroft University of Medical Sciences, Jiroft, Iran
Abstract
Abstracts:
Background: Food allergy is an increasing health problem in children. Previous studies have reported conflicting results about the diagnostic value of atopy patch test (APT) in food allergies.
Objectives: To investigate the accuracy of APT in identifying non-IgE-mediated gastrointestinal food allergy to pasteurized cow's milk, heated cow's milk, white and yolk egg, soy, wheat, walnut, sesame, pistachio, almond, peanut, date and cumin which are popular food ingredients in Iran.
Methods: This study was performed on children with GI allergic problems who did not improve after at least 4 weeks of cow's milk protein elimination. Atopic patch test (APT) was performed and the elimination diet was considered according to APT results and after resolving symptoms, introduction of each accused food was done sequentially.
Results: 53 children under 7 years old with mean age of 19.6 months underwent APT and the results were verified by open oral food challenge. Sensitivity in the rage of 59%-95%, specifity of 80.7-92.8, positive predictive values of 75-96.4 and negative predictive value of 23-80.7% were calculated depending on the type of food. Compared to the heated raw cow's milk, the pasteurized/homogenized cow's milk reaction was significant.
Conclusion: APT can be included in the diagnostic workup of non-IgE-mediated GI allergy because it's safe and has great accuracy. However, several aspects require further investigation especially to enable the standardization of the technique. We should be aware of allegenicity of our foods due to processing and geographic region.
Highlights
parvin Abbaslou(google scholar)(pubmed)
Nasrin Bazargan(google scholar)(pubmed)
maryam ahmadipour(google scholar)(pubmed)
mahdieh Saviz(google scholar)(pubmed)
Keywords
Main Subjects
- Wang J. Management of the patient with multiple food allergies. Curr Allergy Asthma Rep. 2010;10(4):271-7. doi: 1007/s11882-010-0116-0.
- Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: summary of the NIAID-sponsored expert panel report. J Am Acad Dermatol. 2011;64(1):175-92. doi: 1016/j.jaad.2010.11.020.
- Boye JI. Food allergies in developing and emerging economies: need for comprehensive data on prevalence rates. Clin Transl Allergy. 2012;2(1):25. doi: 1186/2045-7022-2-25.
- Sampson HA. Differential diagnosis in adverse reactions to foods. J Allergy Clin Immunol. 1986;78(1 Pt 2):212-9. doi: 1016/0091-6749(86)90014-x.
- Markowitz JE, Venkatesh RD, Moye L, Liacouras CA. Allergic and eosinophilic gastrointestinal disease. In: Wyllie R, Hyams JS, Kay M, eds. Pediatric Gastrointestinal and Liver Disease. Philadelphia, PA: Elsevier; 2021. p. 388-97.
- Bock SA, Atkins FM. Patterns of food hypersensitivity during sixteen years of double-blind, placebo-controlled food challenges. J Pediatr. 1990;117(4):561-7. doi: 10.1016/ s0022-3476(05)80689-4.
- Caubet JC, Nowak-Węgrzyn A. Current understanding of the immune mechanisms of food protein-induced enterocolitis syndrome. Expert Rev Clin Immunol. 2011;7(3):317-27. doi: 10.1586/eci.11.13.
- Nowak-Węgrzyn A. Food protein-induced enterocolitis syndrome and allergic proctocolitis. Allergy Asthma Proc. 2015;36(3):172-84. doi: 10.2500/aap.2015.36.3811.
- Koletzko S, Niggemann B, Arato A, Dias JA, Heuschkel R, Husby S, et al. Diagnostic approach and management of cow’s-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr. 2012;55(2):221-9. doi: 10.1097/MPG.0b013e31825c9482.
- Vandenplas Y, Koletzko S, Isolauri E, Hill D, Oranje AP, Brueton M, et al. Guidelines for the diagnosis and management of cow’s milk protein allergy in infants. Arch Dis Child. 2007;92(10):902-8. doi: 10.1136/adc.2006.110999.
- Sicherer SH, Sampson HA. 9. Food allergy. J Allergy Clin Immunol. 2006;117(2 Suppl 2):S470-5. doi: 10.1016/j. jaci.2005.05.048.
- Mowszet K, Matusiewicz K, Iwańczak B. Value of the atopy patch test in the diagnosis of food allergy in children with gastrointestinal symptoms. Adv Clin Exp Med. 2014;23(3):403- 9. doi: 10.17219/acem/37136.
- Lazzarini R, Duarte I, Ferreira AL. Patch tests. An Bras Dermatol. 2013;88(6):879-88. doi: 10.1590/abd1806- 4841.20132323.
- Wang J. Atopy patch test for the diagnosis of food protein‐induced enterocolitis syndrome. Pediatrics. 2007;120(Suppl 3):S116-7.
- Heine RG, Verstege A, Mehl A, Staden U, Rolinck- Werninghaus C, Niggemann B. Proposal for a standardized interpretation of the atopy patch test in children with atopic dermatitis and suspected food allergy. Pediatr Allergy Immunol. 2006;17(3):213-7. doi: 10.1111/j.1399- 3038.2005.00368.x.
- Wollenberg A, Vogel S. Patch testing for noncontact dermatitis: the atopy patch test for food and inhalants. Curr Allergy Asthma Rep. 2013;13(5):539-44. doi: 10.1007/ s11882-013-0368-6.
- Cocco R, Solé D. Patch test in the diagnosis of food allergy. Allergol Immunopathol (Madr). 2009;37(4):205-7. doi: 10.1016/j.aller.2009.03.003.
- Calvani M, Anania C, Cuomo B, D’Auria E, Decimo F, Indirli GC, et al. Non-IgE- or mixed IgE/non-IgE-mediated gastrointestinal food allergies in the first years of life: old and new tools for diagnosis. Nutrients. 2021;13(1):226. doi: 10.3390/nu13010226.
- Boonyaviwat O, Pacharn P, Jirapongsananuruk O, Vichyanond P, Visitsunthorn N. Role of atopy patch test for diagnosis of food allergy-related gastrointestinal symptoms in children. Pediatr Allergy Immunol. 2015;26(8):737-41. doi: 10.1111/pai.12382.
- Turjanmaa K, Darsow U, Niggemann B, Rancé F, Vanto T, Werfel T. EAACI/GA2LEN position paper: present status of the atopy patch test. Allergy. 2006;61(12):1377-84. doi: 10.1111/j.1398-9995.2006.01136.x.
- Bygum A, Mortz CG, Andersen KE. Atopy patch tests in young adult patients with atopic dermatitis and controls: dose-response relationship, objective reading, reproducibility and clinical interpretation. Acta Derm Venereol. 2003;83(1):18- 23. doi: 10.1080/00015550310002657.
- Jesenák M, Bánovcin P. Atopy patch test in the diagnosis of food allergy in children with atopic dermatitis. Acta Medica (Hradec Kralove). 2006;49(4):199-201. doi: 10.14712/18059694.2017.132.
- Spiewak R. Patch testing for contact allergy and allergic contact dermatitis. Open Allergy J. 2008;1(1):42-51. doi: 10.2174/1874838400801010042.
- Yang H, Xiao YZ, Luo XY, Tan Q, Wang H. Diagnostic accuracy of atopy patch tests for food allergy in children with atopic dermatitis aged less than two years. Allergol Immunopathol (Madr). 2014;42(1):22-8. doi: 10.1016/j. aller.2012.10.007.
- Motala C, Fiocchi A. Cow’s Milk Allergy in Children. World Allergy Organization. Posted October 2011. Updated July 2012. Available from: https://www.worldallergy. org/education-and-programs/education/allergic-disease-resource-center/professionals/cows-milk-allergy-in-children.
- Sampson HA. Update on food allergy. J Allergy Clin Immunol. 2004;113(5):805-19. doi: 10.1016/j.jaci.2004.03.014.
- Scaparrotta A, Di Pillo S, Consilvio NP, Attanasi M, Cingolani A, Rapino D, et al. Usefulness of atopy patch test on a child with milk protein-induced enterocolitis syndrome: a case report. Int J Immunopathol Pharmacol. 2013;26(3):795-800. doi: 10.1177/039463201302600327.
- Nowak-Węgrzyn A, Chehade M, Groetch ME, Spergel JM, Wood RA, Allen K, et al. International consensus guidelines for the diagnosis and management of food protein-induced enterocolitis syndrome: executive summary-Workgroup Report of the Adverse Reactions to Foods Committee, American Academy of Allergy, Asthma & Immunology. J Allergy Clin Immunol. 2017;139(4):1111-26.e4. doi: 10.1016/j.jaci.2016.12.966.
- Chapman JA, Bernstein IL, Lee RE, Oppenheimer J, Nicklas RA, Portnoy JM, et al. Food allergy: a practice parameter. Ann Allergy Asthma Immunol. 2006;96(3 Suppl 2):S1-68.
- Burks AW, Tang M, Sicherer S, Muraro A, Eigenmann PA, Ebisawa M, et al. ICON: food allergy. J Allergy Clin Immunol. 2012;129(4):906-20. doi: 10.1016/j.jaci.2012.02.001.
- Labrosse R, Graham F, Caubet JC. Non-IgE-mediated gastrointestinal food allergies in children: an update. Nutrients. 2020;12(7):2086. doi: 10.3390/nu12072086.
- Bock SA. Prospective appraisal of complaints of adverse reactions to foods in children during the first 3 years of life. Pediatrics. 1987;79(5):683-8.
- Meyer R, Fleming C, Dominguez-Ortega G, Lindley K, Michaelis L, Thapar N, et al. Manifestations of food protein induced gastrointestinal allergies presenting to a single tertiary paediatric gastroenterology unit. World Allergy Organ J. 2013;6(1):13. doi: 10.1186/1939-4551-6-13.
- Sladkevicius E, Nagy E, Lack G, Guest JF. Resource implications and budget impact of managing cow milk allergy in the UK. J Med Econ. 2010;13(1):119-28. doi: 10.3111/13696990903543242.
- Björkstén B. Genetic and environmental risk factors for the development of food allergy. Curr Opin Allergy Clin Immunol. 2005;5(3):249-53. doi: 10.1097/01. all.0000168790.82206.17.
- Garcia-Careaga M Jr, Kerner JA Jr. Gastrointestinal manifestations of food allergies in pediatric patients. Nutr Clin Pract. 2005;20(5):526-35. doi: 10.1177/0115426505020005526.
- Koplin JJ, Allen KJ, Gurrin LC, Peters RL, Lowe AJ, Tang ML, et al. The impact of family history of allergy on risk of food allergy: a population-based study of infants. Int J Environ Res Public Health. 2013;10(11):5364-77. doi: 10.3390/ ijerph10115364.
- Caffarelli C, Cavagni G, Deriu FM, Zanotti P, Atherton DJ. Gastrointestinal symptoms in atopic eczema. Arch Dis Child. 1998;78(3):230-4. doi: 10.1136/adc.78.3.230.
- Niggemann B, Heine RG. Who should manage infants and young children with food induced symptoms? Arch Dis Child. 2006;91(5):379-82. doi: 10.1136/adc.2005.086603.
- Feng CG, Collins AM. Pasteurisation and homogenisation of milk enhances the immunogenicity of milk plasma proteins in a rat model. Food Agric Immunol. 1999;11(3):251-8. doi: 10.1080/09540109999771.
- Nowak-Wegrzyn A, Fiocchi A. Rare, medium, or well done? The effect of heating and food matrix on food protein allergenicity. Curr Opin Allergy Clin Immunol. 2009;9(3):234- 7. doi: 10.1097/ACI.0b013e32832b88e7.
- Abbring S, Ryan JT, Diks MAP, Hols G, Garssen J, van Esch B. Suppression of food allergic symptoms by raw cow’s milk in mice is retained after skimming but abolished after heating the milk-a promising contribution of alkaline phosphatase. Nutrients. 2019;11(7):1499. doi: 10.3390/nu11071499.
- Abbring S, Kusche D, Roos TC, Diks MAP, Hols G, Garssen J, et al. Milk processing increases the allergenicity of cow’s milk- Preclinical evidence supported by a human proof-of-concept provocation pilot. Clin Exp Allergy. 2019;49(7):1013-25. doi: 10.1111/cea.13399.
- CDC. Food Safety; Raw Milk Dangers. Available from: https:// www.cdc.gov/foodsafety/rawmilk/raw-milk-index.html.
- Moghaddam A, Hillson WR, Noti M, Gartlan KH, Johnson S, Thomas B, et al. Dry roasting enhances peanut-induced allergic sensitization across mucosal and cutaneous routes in mice. J Allergy Clin Immunol. 2014;134(6):1453-6. doi: 10.1016/j.jaci.2014.07.032.
- Shen LL, Zhu QQ, Huang FW, Xu H, Wu XL, Xiao HF, et al. Effect of heat treatment on structure and immunogenicity of recombinant peanut protein Ara h 2.01. LWT Food Sci Technol. 2015;60(2 Pt 1):964-9. doi: 10.1016/j. lwt.2014.10.044.
- Hellwig M, Henle T. Baking, ageing, diabetes: a short history of the Maillard reaction. Angew Chem Int Ed Engl. 2014;53(39):10316-29. doi: 10.1002/anie.201308808.
- Zhang T, Shi Y, Zhao Y, Tang G, Niu B, Chen Q. Boiling and roasting treatment affecting the peanut allergenicity. Ann Transl Med. 2018;6(18):357. doi: 10.21037/atm.2018.05.08.
- Arshi S, Khoshmirsafa M, Khalife M, Nabavi M, Bemanian MH, Shokri S, et al. Atopy patch test in the diagnosis of food allergens in infants with allergic proctocolitis compared with elimination/introduction C. Iran J Allergy Asthma Immunol. 2021;20(5):520-4. doi: 10.18502/ijaai.v20i5.7402.
- Davoudi M, Rashighi Firoozabadi M, Gorouhi F, Karimi Zarchi AA, Nasiri Kashani M, Dowlati Y, et al. Patch testing in Iranian patients: a ten-year experience. Indian J Dermatol. 2006;51(4):250-4. doi: 10.4103/0019-5154.30287.
- Jaffary F, Nilforoushzadeh MA, Sadeghian G, Firooz A, Derakhshan R. Patch testing for patients with atopic and contact dermatitis. J Skin Stem Cell. 2014;1(2):e23290.
- Saneian H, Zandieh F, Akhavan P, Taherian R. Value of gluten patch test in diagnosis of celiac disease. Iran J Pediatr. 2011;21(4):491-6.
- Mansouri M, Rafiee E, Darougar S, Mesdaghi M, Chavoshzadeh Z. Is the atopy patch test reliable in the evaluation of food allergy-related atopic dermatitis? Int Arch Allergy Immunol. 2018;175(1-2):85-90. doi: 10.1159/000485126.
- Luo Y, Zhang GQ, Li ZY. The diagnostic value of APT for food allergy in children: a systematic review and meta-analysis. Pediatr Allergy Immunol. 2019;30(4):451-61. doi: 10.1111/ pai.13031.
- Toncić RJ, Lipozencić J. [Atopy patch test--when is it useful?]. Acta Med Croatica. 2011;65(2):97-106.
- Stierstorfer MB, Sha CT, Sasson M. Food patch testing for irritable bowel syndrome. J Am Acad Dermatol. 2013;68(3):377-84. doi: 10.1016/j.jaad.2012.09.010.
- Shin G, Smith M, Toro B, Ehrlich A, Luther S, Midani D, et al. Utility of food patch testing in the evaluation and management of irritable bowel syndrome. Skin (Milwood). 2018;2(2):96- 110. doi: 10.25251/skin.2.2.2.
- Stierstorfer MB, Toro B. Patch test-directed dietary avoidance in the management of irritable bowel syndrome. Cutis. 2021;108(2):91-5. doi: 10.12788/cutis.0321.
- Canani RB, Ruotolo S, Auricchio L, Caldore M, Porcaro F, Manguso F, et al. Diagnostic accuracy of the atopy patch test in children with food allergy-related gastrointestinal symptoms. Allergy. 2007;62(7):738-43. doi: 10.1111/j.1398- 9995.2007.01351.x.
- Sirin Kose S, Asilsoy S, Tezcan D, Atakul G, Al S, Atay O, et al. Atopy patch test in children with cow’s milk and hen’s egg allergy: do clinical symptoms matter? Allergol Immunopathol (Madr). 2020;48(4):323-31. doi: 10.1016/j.aller.2020.03.002.
- Luo Y, Zhang GQ, Li ZY. The diagnostic value of APT for food allergy in children: a systematic review and meta-analysis. Pediatr Allergy Immunol. 2019;30(4):451-61. doi: 10.1111/ pai.13031.