Low efficacy of atopy patch test in predicting tolerance development in non-IgE-mediated cow's milk allergy.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

• Authors: T A Gonzaga, F A Alves, M F A Cheik, C P de Barros, E R M A Rezende, G R S Segundo
• Journal: Allergologia et immunopathologia (Allergol Immunopathol (Madr)) 2018 May - Jun Vol. 46 Issue 3 Pg. 241-246 ISSN: 1578-1267 [Electronic] Singapore
• PMID: 29031891 (Publication Type: Clinical Trial, Journal Article)
• Copyright: Copyright © 2017 SEICAP. Published by Elsevier España, S.L.U. All rights reserved.

Chemical References

• Allergens
• Milk Proteins

Topics

• Allergens (administration & dosage, immunology)
• Animals
• Cattle
• Child, Preschool
• Female
• Humans
• Immune Tolerance (immunology)
• Infant
• Male
• Milk Hypersensitivity (diagnosis)
• Milk Proteins (administration & dosage, immunology)
• Patch Tests (methods)
• Sensitivity and Specificity