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Liu Y, Peng J, Zhou Y, Cui Y. Comparison of atopy patch testing to skin prick testing for diagnosing mite-induced atopic dermatitis: a systematic review and meta-analysis. Clin Transl Allergy 2017; 7:41. [PMID: 29209493 PMCID: PMC5706347 DOI: 10.1186/s13601-017-0178-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/23/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Atopic dermatitis (AD) can occur after contact with aeroallergens like house dust mites, pollen, and animal dander. Despite its controversial diagnostic value, the atopy patch test (APT) has been used as an important tool in the diagnosis of AD caused by house dust mites. Here, we present a meta-analysis comparing APT to the common skin prick test (SPT) in the diagnosis of mite-induced AD. METHODS A structured search was performed using online databases and bibliographies published as of April 30, 2017. All studies evaluating the accuracy of APT and SPT in the diagnosis of mite-induced atopic eczema/dermatitis syndrome were selected, appraised, and data was extracted. RESULTS Ten studies were identified for inclusion in our analysis. Meta-analysis revealed that the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratios for APT were 0.54 (95% CI 0.42-0.66), 0.72 (95% CI 0.56-0.85), 1.97 (95% CI 1.20-3.23), 0.63 (95% CI 0.48-0.83), and 3.12 (95% CI 1.53-6.39). The area under the summary receiver operating characteristic curve was 0.65 (95% CI 0.61-0.69). CONCLUSIONS Our analysis indicates that APT is a useful tool in the screening of mite-induced AD, although this conclusion must be interpreted cautiously due to high heterogeneity among the included studies.
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Affiliation(s)
- Yumei Liu
- School of Public Health, Hainan Medical University, Haikou, 571101 People’s Republic of China
| | - Jianglong Peng
- School of Tropical and Laboratory Medicine, Hainan Medical University, Haikou, 571101 People’s Republic of China
| | - Ying Zhou
- Department of Pediatrics Laboratory, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, 214023 People’s Republic of China
| | - Yubao Cui
- Department of Clinical Laboratory, Wuxi People’s Hospital Affiliated to Nanjing Medical University, No. 299 at Qingyang Road, Wuxi, 214023 Jiangsu Province People’s Republic of China
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Kapur C, Shenoi SD, Prabhu SS, Balachandran C. Patch testing with dermatophagoides and its correlation with chronic eczema and atopic dermatitis. Indian J Dermatol 2011; 54:243-6. [PMID: 20161855 PMCID: PMC2810690 DOI: 10.4103/0019-5154.55633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Chronic eczema is commonly encountered in the Indian set up. So also is atopic dermatitis. House dust mites (Dermatophagoides) are implicated in various diseases like atopic dermatitis, asthma, and perennial rhinitis. It has also been proven that patch testing with Dermatophagoides pteronyssinus (DP) is important for detection of contact sensitization in chronic dermatitis. Aims: To study clinical characteristics of DP mix positive patients with regards to chronic dermatitis and atopic dermatitis. Methods: Dermatology outpatients presenting to the department of Skin and STD of Kasturba Medical College (KMC), with clinically diagnosed atopic dermatitis and chronic eczema were chosen for the study. Inclusion and exclusion criteria were well demarked. Eighty six randomly selected patients of dermatitis were subjected to patch testing with standard series and DP mix. Results: Of the 86, 50 (58%) showed positive reaction to DP mix. Among these positive patients, chronic dermatitis was seen in 42 (84%) with involvement of exposed parts in 37 (74%). Atopic dermatitis was seen in 19 patients (38%) from DP positive group whereas it was observed in 4 patients (17%) from the other group. Conclusion: Dermatophagoides mix positivity was statistically significant in chronic eczema as well as atopic dermatitis. Patch testing is an important tool to detect delayed type allergy to house dust mite.
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Affiliation(s)
- Chetna Kapur
- Department of Skin and STD, Kasturba Medical College, Manipal, India
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3
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Atopy Patch Testing with Aeroallergens and Food Proteins. Contact Dermatitis 2011. [DOI: 10.1007/978-3-642-03827-3_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The atopy patch test (APT), a patch test employing allergens known to elicit IgE-mediated reactions which is assessed by evaluating eczematous skin lesions after 24 h to 72 h, was developed as a diagnostic tool for characterizing patients with aeroallergen-triggered atopic eczema (AE, atopic dermatitis). Positive APT reactions are associated with allergen-specific T-cell responses. The specificity of APT is higher than the specificity of skin prick tests or RAST. More studies for the standardization of APT methods are necessary, especially with regard to food APT.
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Affiliation(s)
- U Darsow
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Technische Universität München.
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Darsow U, Laifaoui J, Kerschenlohr K, Wollenberg A, Przybilla B, Wüthrich B, Borelli S, Giusti F, Seidenari S, Drzimalla K, Simon D, Disch R, Borelli S, Devillers ACA, Oranje AP, De Raeve L, Hachem JP, Dangoisse C, Blondeel A, Song M, Breuer K, Wulf A, Werfel T, Roul S, Taieb A, Bolhaar S, Bruijnzeel-Koomen C, Brönnimann M, Braathen LR, Didierlaurent A, André C, Ring J. The prevalence of positive reactions in the atopy patch test with aeroallergens and food allergens in subjects with atopic eczema: a European multicenter study. Allergy 2004; 59:1318-25. [PMID: 15507101 DOI: 10.1111/j.1398-9995.2004.00556.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The atopy patch test (APT) was proposed to evaluate IgE-mediated sensitizations in patients with atopic eczema (AE). OBJECTIVE The prevalence and agreement with clinical history and specific IgE (sIgE) of positive APT reactions was investigated in six European countries using a standardized method. METHODS A total of 314 patients with AE in remission were tested in 12 study centers on clinically uninvolved, non-abraded back skin with 200 index of reactivity (IR)/g of house dust mite Dermatophagoides pteronyssinus, cat dander, grass, and birch pollen allergen extracts with defined major allergen contents in petrolatum. Extracts of egg white, celery and wheat flour with defined protein content were also patch tested. APT values were evaluated at 24, 48, and 72 h according to the European Task Force on Atopic Dermatitis (ETFAD) guidelines. In addition, skin-prick test (SPT) and sIgE and a detailed history on allergen-induced eczema flares were obtained. RESULTS Previous eczema flares, after contact with specific allergens, were reported in 1% (celery) to 34% (D. pteronyssinus) of patients. The frequency of clear-cut positive APT reactions ranged from 39% with D. pteronyssinus to 9% with celery. All ETFAD intensities occured after 48 and 72 h. Positive SPT (16-57%) and elevated sIgE (19-59%) results were more frequent. Clear-cut positive APT with all SPT and sIgE testing negative was seen in 7% of the patients, whereas a positive APT without SPT or sIgE for the respective allergen was seen in 17% of the patients. APT, SPT and sIgE results showed significant agreement with history for grass pollen and egg white (two-sided Pr > /Z/ < or = 0.01). In addition, SPT and sIgE showed significant agreement with history for the other aeroallergens. With regard to clinical history, the APT had a higher specificity (64-91% depending on the allergen) than SPT (50-85%) or sIgE (52-85%). Positive APT were associated with longer duration of eczema flares and showed regional differences. In 10 non-atopic controls, no positive APT reaction was seen. CONCLUSION Aeroallergens and food allergens are able to elicit eczematous skin reactions after epicutaneous application. As no gold standard for aeroallergen provocation in AE exists, the relevance of aeroallergens for AE flares may be evaluated by APT in addition to SPT and sIgE. The data may contribute to the international standardization of the APT.
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Affiliation(s)
- U Darsow
- Department of Dermatology and Allergy Biederstein, Technical University Munich and Division of Environmental Dermatology and Allergy GSF/TUM, Munich, Germany
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Giusti F, Seidenari S. Reproducibility of atopy patch tests with Dermatophagoides: a study on 85 patients with atopic dermatitis. Contact Dermatitis 2004; 50:18-21. [PMID: 15059098 DOI: 10.1111/j.0105-1873.2004.00277.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Atopy patch tests (APTs) are considered a useful addition to standard testing procedures for the identification of allergens triggering the appearance of eczema in patients with atopic dermatitis (AD). The aim of the study was to evaluate the reproducibility of APTs with house dust mites by simultaneously patch testing AD patients. 85 subjects affected by AD, 36 males and 48 females, aged from 1 to 52 years, were patch tested with Dermatophagoides mix (D. pteron/D. farinae) 20% pet. In our patients, the percentage of agreement between the frequency of positive and negative responses to Dermatophagoides mix was 96.7%. Reproducibility was highly satisfactory, as evaluated by k-value (0.953). As regards the agreement in the intensity of APT responses to Dermatophagoides mix between the right and left sides, we found that reproducibility was also highly satisfactory (k = 0.851). In conclusion, for Dermatophagoides APTs, the agreement rate was similar to that of standard patch tests, and therefore APTs may be considered sufficiently reproducible to be employed as a diagnostic testing procedure.
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Affiliation(s)
- Francesca Giusti
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
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Affiliation(s)
- Vincent S Beltrani
- Department of Dermatology, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
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Seidenari S, Giusti F, Pellacani G, Bertoni L. Frequency and intensity of responses to mite patch tests are lower in nonatopic subjects with respect to patients with atopic dermatitis. Allergy 2003; 58:426-9. [PMID: 12752330 DOI: 10.1034/j.1398-9995.2003.00142.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND So far the issue of patch tests with mite allergens in subjects not affected by atopic dermatitis (AD) has been poorly investigated. The aim of this study was to assess the frequency and intensity of responses to atopy patch tests with Dermatophagoides in non-AD subjects, and to compare them to the ones observed in AD patients. METHODS Patch tests were performed, employing a mixture of Dermatophagoides pteronyssinus and farinae at two different concentrations (20 and 40% pet.), on 75 non-AD subjects, including 33 patients with allergic rhinitis and 42 healthy volunteers, and on 210 AD patients, as controls. RESULTS Positive responses to 20% mite patch tests were observed in 17 non-AD subjects (23%) and in 102 AD ones (49%). The former showed a lower intensity of the responses, with a mean score of 1.4 compared with 2.1 in atopics. CONCLUSIONS Although positive responses to mite patch tests are also observable in subjects without AD, their frequency and intensity are significantly lower compared with AD patients.
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Affiliation(s)
- S Seidenari
- Department of Dermatology, University of Modena and Reggio Emilia, Italy
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Ingordo V, D'Andria G, D'Andria C, Tortora A. Results of atopy patch tests with house dust mites in adults with 'intrinsic' and'extrinsic' atopic dermatitis. J Eur Acad Dermatol Venereol 2002; 16:450-4. [PMID: 12428836 DOI: 10.1046/j.1468-3083.2002.00525.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The most frequently employed diagnostic criteria of atopic dermatitis (AD) can be fulfilled in the absence of elevated total circulating IgE or specific IgE to food allergens or environmental aeroallergens and/or in the absence of personal or familial history of atopy as well. Therefore a distinction between 'extrinsic' or 'allergic' and 'intrinsic' or 'non-allergic' AD has been suggested. Recently, a patch test with environmental aeroallergens, named atopy patch test (APT), has been proposed for use in the study of AD. OBJECTIVE The aim of this study was to investigate the reactivity to APT in patients with 'extrinsic' and 'intrinsic' AD. PATIENTS, MATERIALS AND METHODS Two groups of adult male subjects with AD were examined consecutively in our department (Department of Dermatology, Italian Navy Main Hospital, Taranto, Italy) andpatch tested with whole bodies of house dust mites (HDM) at a concentration of 20% in petrolatum (Dermatophagoides pteronyssinus 50%, D. farinae 50%). The groups included: (i) 95 patients affected by the adult clinical form of 'extrinsic' AD; (ii) 12 patients affected by the adult clinical form of 'intrinsic' AD; and (iii) a control group of 49 adult healthy male subjects with a negative anamnesis for eczema and atopy and negative skin prick test to aeroallergens/food allergens and/or normal level of total circulating IgE, also patch tested with the same allergen. The statistical differences were calculated by chi2 test and 95% confidence intervals (CI) were provided. RESULTS The APT was positive in 47.4% (CI: 37-57%) of'extrinsic'AD, in 66.6% (CI: 41-93%) of'intrinsic' AD and in 12.2% (CI: 3-21%) of healthy subjects. The differences between the two AD subgroups and the control group were statistically significant (P < 0.001). CONCLUSIONS APT positivity is more frequent in both 'extrinsic' and 'intrinsic' AD than in unaffected subjects. Other studies are needed to confirm our data and to explain why the APT is positive in the 'intrinsic' form.
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Affiliation(s)
- V Ingordo
- Department of Dermatology, Italian Navy Main Hospital M.O. Giulio Venticinque Taranto.
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Brasch J, Uter W, Dibo M, Stockfleth E, Swensson O, Christophers E. Positive patch tests with a dermatophagoides mix relate to an increased responsiveness to standard patch test allergens. Contact Dermatitis 2002; 46:253-7. [PMID: 12084076 DOI: 10.1034/j.1600-0536.2002.460501.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The diagnostic meaningfulness of patch tests with house dust mite allergens is still questionable. Our own impression has been that positive results with a dermatophagoides mix may occur preferentially in patients with a generally enhanced responsiveness to contact allergens. To check this, all of our patients allocated to patch testing with the standard series were additionally patch tested with a dermatophagoides mix by the same technique that was used for standard contact allergens. Out of 571 patients tested, 188 showed delayed responses to this mix that were indistinguishable from typical allergic patch test reactions but of no apparent clinical relevance. No relationship was found between positive dermatophagoides patch tests and an atopic disposition of the patients or characteristics of their eczema. However, 64.4% of the patients with a positive dermatophagoides patch test showed a response to at least 1 contact allergen of the standard series, compared to only 56.4% of the patients without a positive dermatophagoides reaction (p < 0.05). The reactivity to the mite mix was not related to the responsiveness towards any particular contact allergens. We suppose that some unidentified factors may contribute to positive reactions to the dermatophagoides mix that may also favour an enhanced general responsiveness to contact allergens.
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Affiliation(s)
- Jochen Brasch
- Department of Dermatology, University of Kiel, Germany.
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Isobe T, Kato Y, Okubo Y, Koga M. Evaluation of Patch Testing in Atopic Dermatitis Using Commercially Available Environmental Antigens. Allergol Int 2001. [DOI: 10.1046/j.1440-1592.2001.00215.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ricci G, Patrizi A, Specchia F, Menna L, Bottau P, D'Angelo V, Masi M. Mite allergen (Der p 1) levels in houses of children with atopic dermatitis: the relationship with allergometric tests. Br J Dermatol 1999; 140:651-5. [PMID: 10233315 DOI: 10.1046/j.1365-2133.1999.02764.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Several studies, in particular in adult groups, have evaluated the involvement of mites in the pathogenesis of atopic dermatitis (AD). This still remains controversial. The objective of this study was to determine the level of house dust mites (HDMs) in the beds of a group of children with AD and correlate these levels with their allergometric assessment. Forty-one children with AD underwent allergometric tests (prick test, patch test and radioallergosorbent test, RAST) and the concentration levels of HDMs in their homes were evaluated. Our data show that about half of the children (51%) with AD presented Dermatophagoides pteronyssinus positivity (prick test and/or RAST and/or patch test). Dust was collected in the period October-November from the children's beds, by the same two operators, using a dust-collection device. The dust mite level was tested by an enzyme-linked immunosorbent assay with antibody against Der p 1 allergen. Ten children (24%) presented a Der p 1 concentration > 2 microgram/g of dust (the value assumed to be a risk level for sensitization), 20 (49%) between 0.1 and 2 microgram/g and 11 (27%) < 0.1 microgram/g of dust. In the group with the highest Der p 1 concentration (> 2 microgram/g dust) nine children (90%) presented an allergometric D. pteronyssinus sensitivity, the difference with the other two groups being statistically significant at P < 0.018. The results of the present study show that the highest HDM concentrations were observed in the group with an allergometric D. pteronyssinus positivity (prick test and/or RAST and/or patch test). It is hypothesized that a higher HDM concentration may elicit D. pteronyssinus IgE sensitization and delayed hypersensitivity in children with AD.
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Affiliation(s)
- G Ricci
- Department of Pediatrics, University of Bologna, Italy.
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