Relationship between skin prick and atopic patch test reactivity to aeroallergens and disease severity in children with atopic dermatitis

doi:10.1016/j.aller.2013.02.007

Allergologia et Immunopathologia

Volume 41, Issue 6, November–December 2013, Pages 369-373

https://doi.org/10.1016/j.aller.2013.02.007 Get rights and content

Abstract

Background

The immunological mechanism in aetiology of atopic dermatitis (AD) shows significant differences from other allergic diseases. Allergen inhalation exacerbates AD lesions and AD patients’ complaints decrease in house dust mite (HDM) low level environments, which reveals the importance of inhalant allergens.

Objective

We evaluated the skin prick test (SPT) and atopy patch test (APT) positivity rates with aeroallergens and studied the effect of test results, and aimed to determine the value of allergic test reactivity on the clinical characteristics of children with AD.

Methods

Forty-five children aged 2–15 years with AD were included to study between May 2006 and May 2007 in GATA Haydarpasa Teaching Hospital, Allergy Department. The reactivity to inhalant allergens using SPT and APT was evaluated. The severity of AD, which was assessed with SCORAD, was compared with aeroallergen hypersensitivity.

Results

The highest positivity of APT was seen against HDM (48.9%). HDM SPT positivity and subjective symptoms score were statistically correlated (P < 0.05). Patients with strong SPT positivity to HDM had a higher total SCORAD score (P < 0.05). Although there was no statistical correlation between HDM APT and SCORAD parameters, APT positive patients had generally higher SCORAD parameters. The statistical significance was only shown between the extent of the disease and strong APT positive reactions to Dermatophagoides pteronyssinus.

Conclusion

HDM allergens play an important role in determining the clinical severity of AD and strong APT positivity could be more meaningful clinically.

Introduction

Atopic dermatitis (AD) affects children with a wide degree of severity. The immunological mechanism in aetiology of AD shows significant differences from other allergic diseases. Allergen exposure plays an important role in AD. Allergen inhalation exacerbates AD lesions and AD patients’ complaints decrease in house dust mite (HDM) low level environments, which reveals the importance of inhalant allergens in AD.1, 2

It was shown that HDM are capable of inducing the release of multiple chemokines and pro-inflammatory cytokines from epidermal keratinocytes and dermal fibroblasts.³

The basic role of T lymphocyte in the physiopathology of AD lesions and its importance in late reactions4, 5 brings forth the atopy patch test (APT) despite its controversial diagnostic value in clinical use.⁶

We evaluated the skin prick (SPT) and APT reactivity to aeroallergens and studied the relationship of test results to the clinical characteristics of children with AD.

Section snippets

Materials and methods

The study was approved by the local ethics committee, and written informed consent was given by the child's parents prior to enrolment.

Forty-five children aged 2–15 years with AD who applied to GATA Haydarpasa Teaching Hospital, Department of Allergy between May 2006 and 2007 were included in the study. All patients were tested using the prick test method with lancet. A standardised panel (ALK-Abello, Madrid, Spain) including HDM (Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinea

Results

45 patients, 21 (46.7%) male and 24 (53.3%) female, diagnosed with atopic dermatitis, were included in the study according to the Hanifin Rajka criteria. Mean age of the patients was 82.77 ± 43.76 (24–180) months. Average age of onset was 26.44 ± 28.8 (2–120) months. 25% of the patients were at or under the age of three. Mean duration of disease was 56 ± 41.1 (9–174) months.

SPT were positive in 68.9% of patients with aeroallergens. The HDM was the most common allergen (Fig. 1).

Highest positivity of

Discussion

Rapidly developing symptoms (type-1 reactions) caused by allergens in allergic diseases can be easily diagnosed with detailed anamnesis, skin tests and/or specific IgE level measurements. However, diagnostic approaches are rather complex in late onset reactions, such as AD. The role of pollutants and allergens of the indoor air in the pathogenesis and clinical features of AD have not been investigated in detail.

It is reported that APT has a higher specificity than SPT and sIgE in the evaluation

Protection of human subjects and animals in research

The authors declare that the procedures followed were in accordance with the regulations of the responsible Clinical Research Ethics Committee and in accordance with those of the World Medical Association and the Helsinki Declaration.

Confidentiality of data

The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in

Conflict of interest

The authors have no conflict of interests to declare.

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Citation Excerpt :
In the present study, we used these locally lyophilized allergen extracts for APTs and SPTs. We also performed SPTs and APTs with house dust mite and cockroach allergen extracts because dust mites and cockroaches are reported causes of atopic dermatitis exacerbation.20–26 The purpose of this study was to evaluate APT and SPT results in children with atopic dermatitis, using locally lyophilized food allergen extracts (cow's milk, egg white, egg yolk, wheat, soy, and salt water shrimp), as well as Dermatophagoides pteronyssinus, Dermatophagoides farinae, and commercial American cockroach allergen extracts.
Atopic dermatitis is frequently associated with food and/or aeroallergen allergy.
To evaluate atopy patch tests (APTs) and skin prick tests (SPTs) in children with atopic dermatitis, using allergen extracts from locally lyophilized foods (cow's milk, egg white, egg yolk, wheat, soy, and shrimp), Dermatophagoides pteronyssinus, Dermatophagoides farinae, and American cockroach.
This study was a prospective, self-controlled study in children with atopic dermatitis. APTs, SPTs, and oral food challenge tests were performed in the cases with written informed consent.
Fifty-six children with atopic dermatitis were enrolled. According to the Severity Scoring of Atopic Dermatitis Index, moderate atopic dermatitis was the most common severity (49.1%) followed by mild (20%) and severe atopic dermatitis (13.2%). APT results were positive for food allergens in 49% of participants; SPT results were positive in 54.7%. The sensitivity, specificity, positive predictive value, and negative predictive value of APTs for foods were 40%, 90.2%, 65.2%, and 76.6%, respectively. For SPTs, those values were 40%, 93.9%, 75%, and 77.3%, respectively. APT results for D farinae, D pteronyssinus, and American cockroach were positive in 33.9%, 35.8%, and 21.8% of participants, respectively. SPT results for these allergens were positive in 28.3%, 24.5%, and 9.4% of participants, respectively. No serious complications occurred.
APTs with locally prepared lyophilized allergen extracts were safe and had high specificity, median positive predictive value, and low sensitivity for evaluation of suspected food allergy in children with atopic dermatitis.
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Original articleRelationship between skin prick and atopic patch test reactivity to aeroallergens and disease severity in children with atopic dermatitis

Abstract

Background

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Materials and methods

Results

Discussion

Protection of human subjects and animals in research

Confidentiality of data

Conflict of interest

Asia Pac Allergy

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

Allergol Int

Guidelines for treatment of atopic eczema (atopic dermatitis) part I

J Eur Acad Dermatol Venereol

Immunomodulation of skin cytokine secretion by house dust mite extracts

Int Arch Allergy Immunol

Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report

Allergy

Original article
Relationship between skin prick and atopic patch test reactivity to aeroallergens and disease severity in children with atopic dermatitis