Original article
Comparison of results of skin tests, RAST, and double-blind, placebo-controlled food challenges in children with atopic dermatitis,☆☆

https://doi.org/10.1016/0091-6749(84)90083-6Get rights and content

Abstract

Forty children with atopic dermatitis were evaluated for clinical evidence of hypersensitivity to foods by double-blind, placebo-controlled food challenges. Twenty-four children (60%) experienced 33 positive challenges, manifested by cutaneous symptoms in 31 (94%), gastrointestinal symptoms in 14 (42%), nasal symptoms in nine (27%), and respiratory in six (18%). Results of prick skin tests (STs) and RASTs to eight food antigens frequently eliciting hypersensitivity reactions were compared with those from food challenges to determine the diagnostic accuracy in children with atopic dermatitis. Defining a positive ST as a wheal 3 mm larger than the negative control wheal and a positive RAST as a Phadebas RAST score of 3 or 4, the sensitivity, specificity, and predictive accuracies of these tests were found to be comparable except in the case of wheat antigen where the ST was clearly superior to the RAST. Accepting a RAST score of 2 or more as a positive slightly improved sensitivity in some cases but dramatically decreased specificity. Combining results of STs and RASTs did not improve significantly the diagnostic accuracy over results of the tests used individually. These studies demonstrate no advantage of RAST alone or in combination with prick skin testing over prick skin testing alone in the evaluation of food hypersensitivity in children with atopic dermatitis. Furthermore, skin testing should be considered a good test for excluding immediate food hypersensitivity but only a suggestive positive indicator of hypersensitivity due to the high rate of clinically insignificant positive STs.

References (25)

  • NF Adkinson

    The radioallergosorbent test: Uses and abuses

    J Allergy Clin Immunol

    (1980)
  • NF Adkinson

    The radioallergosorbent test

    J Allergy Clin Immunol

    (1980)
  • Cited by (0)

    Supported by grant AI 19116 from the National Institute of Allergy and Infectious Diseases and by grant RR-30 from the General Clinical Research Centers Program of the Division of Research Resources, National Institutes of Health.

    ☆☆

    Presented in part at the Thirty-ninth Annual Meeting of the American Academy of Allergy and Immunology, March, 1983, Hollywood, Fla.

    View full text