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Diagnosis of IgE-mediated food allergy among Swiss children with atopic dermatitis

Authors


Philippe A. Eigenmann, MD, Allergy Unit, University Hospital of Geneva, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland
Tel.: + 41-22-372 9417
Fax: + 41-22-372 9369
E-mail: Philippe.Eigenman@hcuge.ch

Abstract

Diagnosis of food allergy in children with atopic dermatitis (AD) relies on a good knowledge of the prevalence of the disease and of the foods most frequently involved. Our objective was to define these characteristics in a population of Swiss children with AD. Patients referred to a pediatric allergist or a dermatologist for AD were routinely tested by skin-prick test (SPT) to seven common food allergens (milk, egg, peanut, wheat, soy, fish, and nuts), and to all other foods suspected by history. Patients with positive SPTs were further evaluated for specific serum immunoglobulin E (IgE) antibodies (by using the CAP System FEIA). CAP values were interpreted following previously published predictive values for clinical reactivity. Patients with inconclusive results (between the 95% negative predictive value [NPV] and the 95% positive predictive value [PPV]) were challenged with the suspected food. A total of 74 children with AD were screened for food allergies. Negative SPTs excluded the diagnosis in 30 subjects. Nineteen patients were diagnosed by histories suggestive of recent anaphylactic reactions to foods and/or CAP values above the 95% PPV. Forty-three food challenges (35 open challenges and eight double-blind, placebo-controlled in children with persistent lesions of AD despite aggressive topical skin treatment) were performed in patients with positive SPTs but with inconclusive CAP values. Six patients were diagnosed as positive to 15 foods. Challenges were not performed to high-allergenic foods in young children (under 12 months of age for egg and fish, and under 3 years of age for peanuts and nuts). Altogether, 33.8% (25 of 74) of the AD patients were diagnosed with food allergy. The prevalence of food allergy was 27% (seven of 25) in the group referred to the dermatologist for primary care of AD. The foods most frequently incriminated were egg, milk, and peanuts. The prevalence of food allergy in our population was comparable to that in other westernized countries, suggesting an incidence of food allergy in approximately one-third of children with persistent lesions of AD. Together with milk and eggs, peanuts were most frequently involved in allergic reactions.

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