engleski

Atopy Patch Test in Children with Cow’s Milk Protein Allergy - Our Experiences

Atopy patch test has been increasingly used in children with suspected cow's milk protein allergy. Yet in spite of numerous studies the test itself has not been standardized. We have presented two clinical studies performed in our Clinic. The first study enlisted 151 children, age 3 weeks to 24 months, who exhibited suspect skin (50/151), gastrointestinal (67/151) or both (34/151) manifestations of a food allergy to cow's milk, and in whom tests failed to prove early type of allergic reaction. Atopy patch test with cow's milk was performed in all patients. The second study enlisted 61 patients, age 3 weeks to 4 years, who presented with gastrointestinal symtoms suggestive of cow milk allergy. Beside gastrointestinal symptoms, 24/61 patients had also symptoms of atopic dermatitis. Atopy patch test and open food challenge test with cow's milk based infant formula were performed in all patients. In the first study, atopy patchtest was positive in 14/50 (28.0%) of the children with atopis dermatitis, 29/67 (43.3%) of the children with suspect gastrointestinal manifestation and 11/34 (32.4%) of the children with skin and gastrointestinal manifestations. In the second study, atopy patch test was positive in 31/61 patients (50.8%), and 11/31 (18.0%) patients had strongly or very strongly positive reaction. From all patients with positive atopy patch test, 22/31 had positive openfood challenge test. In children with negative atopy patch test, open food challenge test has confirmed the diagnosis of cow milk allerga in 10/33 (33.33%), false negative). In general, atopy patch test yielded sensitivity of 68.75%, specificity 68.97%, PPV 70.97%, and NPV of 66.67%. However, sensitivity for strongly and very strongly reaction was 50%, specificity 95.23%, PPV 90.90%, and NPV was 66.67%. There was no difference in test efficacy in respect to the clinical presentation. Atopy patch test ina n excellent addition to the hitherto used tests for the diagnostics of food allergies. It targets specifically delayed type hypersensitivity reactions, which are difficult to confirm with other diagnostic means. It is furthermore simple to perform, non-invasive and produces a minimum of desired side effects. For these reasons, it should become part of the routine diagnostic toolset for food allergies to cow milk in infants and children, and applied before a food challenge test.

atopy patch test; cow milk allergy; atopic dermatitis

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