The association of maternal prenatal IgE and eczema in offspring is restricted to non-atopic mothers

The risk of developing eczema is thought to be influenced by both genetic and environmental factors. Prenatal factors including the intrauterine environment may influence risk. We examined the relationship of maternal total IgE obtained during pregnancy to the incidence of atopic dermatitis in their 2-yr-old offspring. Subjects were participants in an unselected Detroit area birth cohort. Serum IgE was measured from 458 mothers in the third trimester of pregnancy along with prenatal family and environmental histories. Children were evaluated at approximately 2 yr of age for current or past eczema by maternal questionnaire and physician examination. Among the 458 children, 20.3% (n = 93) had a doctor confirmed diagnosis of eczema. Prenatal IgE was higher among women whose children developed AD vs. women whose children did not [Geometric means and 95% confidence intervals 52.7 IU/ml (40.9-68.0) vs. 32.9 IU/ml (28.0-38.7), p = 0.010]. The association was only seen in a subgroup of 181 women without allergic sensitization (specific IgE >0.35 IU/ml) to a panel of eight common allergens. Of the women without allergic sensitization, the mean serum IgE was 24.1 IU/ml (15.5-37.6) among those whose children had a diagnosis of eczema. The mean serum IgE was 11.2 IU/ml (9.2-13.6) among those whose children did not have a diagnosis of eczema (p-value 0.002). Maternal prenatal IgE level among women who are not sensitized to common allergens is associated with increased risk of eczema in offspring.     

Does the severity of atopic dermatitis correlate with serum IgE levels?

Recent studies suggest an association between atopic phenotypes and serum IgE levels. In contrast to asthma, this association has not been proven for atopic dermatitis. For 345 children (mean age 2.9 years), we investigated a correlation of the severity of eczema (defined by SCORAD score) and serum IgE levels. Additionally, the data was analyzed for differences between children with high and low SCORAD quartile. Parameters such as genetic background, the prevalence of other atopic phenotypes such as bronchial asthma, allergic rhinoconjunctivitis, and allergic sensitization were recorded. Our results indicate a significant correlation between SCORAD and serum IgE levels (R = 0.31, p < 0.001), but the standard deviation was large. Children with atopic dermatitis showed a high prevalence of sensitization to foods independent of the IgE levels; children with high SCORAD levels showed a sensitization to aeroallergens significantly more often (p < 0.02). No differences were found in prevalences of atopic family background, or a number of additional atopic symptoms such as asthma and allergic rhinoconjunctivitis. These results suggest that serum IgE levels seem to correlate with the degree of eczema. Children with severe atopic dermatitis and high IgE levels are at risk for sensitization to food allergens and aeroallergens.     

437例变态反应性疾病患儿血清特异性IgE抗体检测和分析

目的：了解长沙地区儿童变态反应性疾病的过敏原状况。方法：采用AllergyScreen过敏原定量检测系统检测437例变态反应性疾病患儿血清中总IgE和特异性IgE抗体水平。结果：总IgE阳性率为68.9%,特异性IgE阳性率为69.1%;常见过敏原为户尘螨粉尘螨、牛肉、羊肉、牛奶、猫狗毛皮屑。户尘螨粉尘螨阳性率在变应性鼻炎中最高,达86.0%,特应性皮炎次之,为41.2%,湿疹、荨麻疹相对较低,分别为27.6%,20.0%;猫狗毛皮屑在特应性皮炎、湿疹中相对较高,为23.5%和18.1%,在荨麻疹和变应性鼻炎中较低,为10.0%和8.7%;牛奶、牛肉、羊肉的阳性率在这4种过敏性疾病中均较高,但在4种过敏性疾病之间差别不明显。3岁以上吸入性过敏原阳性率明显高于3岁以下（P＜0.01）。结论：在长沙地区,过敏原对儿童变态反应性疾病有着重要影响,特别是户尘螨粉尘螨、猫狗毛皮屑、牛肉、羊肉、牛奶。［中国当代儿科杂志,2009,11（7）：543-545］     

Sensitization to food and airborne allergens in children with atopic dermatitis followed up to 7 years of age

Previously we investigated the eczema prognosis and the risk of developing allergic asthma and rhinitis in a cohort of 94 children with atopic dermatitis. In this second study on the same cohort we address the development of sensitization to foods and airborne allergens, risk factors and, the question whether children with atopic dermatitis who will not become sensitized can be recognized early. Children with atopic dermatitis were followed up regularly from infancy or early childhood to 7 years of age with clinical examination and blood sampling. After age 3, skin prick tests with inhalation allergens were performed yearly. In most children both clinical allergy and sensitization to egg and milk were transient but those to peanut were persistent. Eighty per cent of the children became sensitized to airborne allergens and 75% of them noticed symptoms when exposed. Heredity for atopy and eczema, sensitization to hen's egg, and early onset of eczema entailed an increased risk of becoming sensitized. Children never sensitized had late onset of eczema and less heredity for atopic disease but did not differ in other respects from the sensitized children.     

Quantification of IgE antibodies simplifies the classification of allergic diseases in 4-year-old children. A report from the prospective birth cohort study – BAMSE

Allergic diseases are common among small children, but it is still unclear how immunoglobulin E (IgE) antibodies to ambient allergens are distributed in a population‐based prospective material of children at 4 years of age. The study is based on 75% (n = 4089) of all eligible children from northern Stockholm, born between 1994 and 1996 in pre‐defined geographical areas. Data on exposure and outcome were obtained by parental questionnaires when the child was 3 months and 4 years of age. Of the 92% who responded to the 4 years of age questionnaire, serum was obtained in 88% of these children for analysis of IgE antibodies performed with Pharmacia CAP system^TM (Phadiatop^® and food mix fx5^®). An antibody level ≥0.35 kU_A/l was considered as positive. A positive Phadiatop^® or fx5^® was found in 24% of the 4 years old children. A rather poor correlation was found between the two tests (r = 0.39). Occurrence of IgE antibodies ≥3.5 kU/l for both Phadiatop^® and fx5^® in combination could predict any suspected allergic disease [asthma, rhinitis, atopic eczema dermatitis syndrome (AEDS) and allergic reaction to food] to 97.4%. However, the presence of ≥3.5 kU_A/l of Phadiatop^® or fx5^® used as single tests only, was far less efficient to predict any allergic disease. The two mixes of airborne and food allergens were also associated, not only to the severity of the allergic disease in terms of number of organ involved, but also to the severity of recurrent wheeze, in particular in boys with a positive Phadiatop^® who exhibited significantly limited peak flows compared to those with a negative test. Already at the age of 4, one child in four is sensitized to an allergen as assessed by Phadiatop^® or food mix (fx5^®). The presence of IgE antibodies seems not only to predict allergic diseases in this age group, but also relates to severity of such diseases, in particular to asthma. Notable, there was a poor correlation between Phadiatop^® and fx5^® that needs to be considered when identifying allergic diseases in young children. The study demonstrates that quantification of IgE antibodies in blood may be beneficial, not only to diagnose allergic diseases in young children, but especially to serve as a marker of severity of asthma.     

The relationship among markers of allergy, asthma, allergic rhinitis, and eczemain Costa Rica

The association between allergy markers and asthma and allergic rhinitis is stronger in countries with a Western lifestyle than in rural areas of Africa and Asia. We examined the relationship among allergy markers, asthma, rhinitis, and eczema in a case-control study of 198 schoolchildren, 10–13 years of age, living in Costa Rica, a Latin American country. The geometric mean total serum immunoglobulin E (IgE) level in subjects with and without asthma was 465.0 and 143.0 IU/ml, respectively (difference = 322 IU/ml, 95% CI = 141.8–616.1 IU/ml, p < 0.001), and that in subjects with and without allergic rhinitis was 442.5 and 144.3 IU/ml, respectively (difference = 298.2 IU/ml, 95% CI = 125.7–581.0 IU/ml, p < 0.001). After adjusting for age, gender, and skin test reactivity to allergens, we found a linear relationship between serum total IgE level and the log odds ratio (OR) of having asthma. In a multivariate analysis, there was a linear relationship between skin test reactivity to allergens and the log OR of having allergic rhinitis. The OR of having allergic rhinitis was almost three times higher in children who had four positive skin tests than in non-reactors. Skin test reactivity to greater than five aeroallergens was an independent predictor of eczema in a multivariate analysis (OR = 3.1, 95% CI = 1.1–8.4). Although the geometric mean total serum IgE levels of Costa Rican children with either asthma or allergic rhinitis are higher than those of children with asthma or allergic rhinitis in most industrialized countries, the relationship among markers of allergy, asthma, rhinitis, and eczema in Costa Rica is similar to that found in countries with a Western lifestyle and different from that found in rural areas of Asia and Africa.     

Clinical and immunological aspects of food allergy in childhood. I. Estimation of IgG, IgA and IgE antibodies to food antigens in children with food allergy and atopic dermatitis

Sixtynine children with case histories of food intolerance and 30 food tolerant children with atopic dermatitis have been investigated regarding serum IgE levels and IgE-, IgG, and IgA-antibodies to some common foods. Children with food intolerance had significantly higher IgE levels and to a larger extent specific IgE antibodies to the tested allergens. IgE antibodies to cow's milk were found in 71% of the children with histories of cow's milk allergy but occurred also in similar titers in 27% of milk tolerant children with other food allergies. IgE antibodies to egg-white occurred in 88% of egg allergies, but low and moderate titers were also found in 17% of children without food intolerance. However, all children with high titers had symptoms of egg allergy. IgE antibodies to the fish allergen were only found in fish allergic children while IgE antibodies to the fish allergen were only found in fish allergic children while IgE antibodies to soy-bean and green peas were found less consistently. The level of serum IgA antibodies to milk was similar in both groups. The IgG antibody titers to all tested food antigens seemed to parallel the IgE antibody titer to the same food. It was not possible to correlate the IgG antibody titers to symptoms.     

Occurrence of acute diarrhea in atopic and nonatopic infants: the role of prolonged breast-feeding.

A cohort of 336 infants was followed from birth for a total of 717 child-years for development of atopy and occurrence of acute diarrhea. During follow-up 94 (28%) of the infants developed atopic eczema or gastrointestinal allergy associated with food allergens, or both. Infants with food allergy had significantly (p = 0.0074) more episodes of acute diarrhea than infants with no atopy, but there was no apparent temporal correlation between the occurrence of acute diarrhea and appearance of gastrointestinal allergy or atopic eczema. Serum IgE levels in children up to 2 years of age who had diarrhea and atopic eczema were lower than those in atopic eczema children with no diarrhea, but infants with gastrointestinal allergy who had acute diarrhea tended to have higher IgE levels than those without diarrhea. Breast-feeding over 6 months of age reduced the incidence of diarrhea in the first year of life in both atopic and nonatopic infants, but had no significant effect on the total incidence of diarrhea during the 2 year follow-up, as infants breast-fed longer had more diarrhea in the second year of life. Prolonged breast-feeding also reduced the severity of diarrhea in atopic infants aged 7-12 months but not for older infants.     

Latex type I sensitization and allergy in children with atopic dermatitis. Evaluation of cross‐reactivity to some foods

Recent studies have demonstrated that allergy to natural rubber latex (NRL) is associated with cross-reactivity to certain foods. The aim of this study was to investigate the prevalence of NRL sensitization and allergy in children with atopic dermatitis (n=74). We also examined cross-reactions between latex and foods, and compared the frequency of suspected latex cross-reacting fruits in children with and without NRL-specific immunoglobulin E (IgE). Twelve of the 74 atopic children studied (16.2%; 95% confidence interval (CI), 8.7–26.6%) had circulating IgE antibodies to latex. These NRL-sensitized children were older and they showed significantly higher total IgE values (p<0.003) when compared with the group of children without NRL sensitization. Of the specific food IgE evaluations, 18.4% (93 out of 505) were positive, and 69.9% were observed in the group of children with latex-specific IgE, most frequently to potato, tomato, sweet pepper, and avocado. An isolated latex-specific IgE response without food-specific IgE was never observed. Exclusively in the latex-positive group, conformity with the report of allergic symptoms after ingestion of food and increased food-specific IgE was found. Twenty children without proven latex sensitization showed increased food-specific IgE, most frequently to potato, banana, and chestnut. Avocado-specific IgE was never determined in this patient group. No significant differences were detected concerning the sensitization to potato, banana, and kiwi between NRL-sensitized children and the group of 20 children without latex-specific IgE. The competitive CAP inhibition using sera from children with specific IgE to both latex and food showed different cross-reactivities between latex and the specific food. A close relationship existed between latex and avocado (median inhibition: 100%), whereas sensitization to latex and kiwi seemed to be independent in our study group (inhibition: <25%). In particular, for potato, cross-reactivity and co-sensitization existed. Our study demonstrated that children with atopic dermatitis are a high-risk group for latex sensitization. Increasing age, additional sensitization to ubiquitous inhaled allergens, and enhanced total serum IgE values seemed to be important variables for latex sensitization and further sensitization to the latex-associated foods. Cross-reactivity and, in some cases, co-sensitization to specific fruits and vegetables, were observed.     

CLINICAL AND IMMUNOLOGICAL ASPECTS OF FOOD ALLERGY IN CHILDHOOD I. Estimation of IgG, IgA and IgE Antibodies to Food Antigens in Children with Food Allergy and Atopic Dermatitis

Abstract Sixtynine children with case histories of food intolerance and 30 food tolerant children with atopic dermatitis have been investigated regarding serum IgE levels and IgE-, IgG, and IgA-antibodies to some common foods. Children with food intolerance had significantly higher IgE levels and to a larger extent specific IgE antibodies to the tested allergens. IgE antibodies to cow's milk were found in 71% of the children with histories of cow's milk allergy but occurred also in similar titers in 27% of milk tolerant children with other food allergies. IgE antibodies to egg-white occurred in 88% of egg allergies, but low and moderate titers were also found in 17% of children without food intolerance. However, all children with high titers had symptoms of egg allergy. IgE antibodies to the fish allergen were only found in fish allergic children while IgE antibodies to soy-bean and green peas were found less consistently. The level of serum IgA antibodies to milk was similar in both groups. The IgG antibody titers to all tested food antigens seemed to parallel the IgE antibody titer to the same food. It was not possible to correlate the IgG antibody titers to symptoms.     

Significant improvement of eczema with skin care and food elimination in small children

Aim: To evaluate common methods of investigation and treatment in children younger than 2 y of age with eczema, with or without sensitization to food allergens. Methods: One hundred and twenty-three children younger than 2 y of age with eczema and suspected food allergy were included in this prospective study. The children underwent skin-prick test with cow's milk, fresh hen's egg white and wheat. Specific IgE to milk and egg white was analysed. The eczema extent and severity was estimated with SCORAD before and after treatment. Children with a positive skin-prick test were instructed to exclude that food item from their diet. All children were treated with emollients and topical steroids when needed. Results: Sixty-two of the children were skin-prick positive to at least one of the allergens; 62% had mild, 30% moderate and 8% severe eczema at their first visit. After treatment, 90% had mild, 10% moderate and 0% severe eczema. Forty-six per cent of the children had circulating IgE antibodies to milk or egg white. Ten per cent had specific IgE but negative skin-prick test to the same allergen. This subgroup improved their eczema significantly without elimination diet.

Conclusion: The conventional treatments for children with eczema, i.e. skin care and food elimination, are effective. The beneficial effect of skin care as the first step should not be neglected, and it may not be necessary to eliminate food allergens to relieve skin symptoms in all food-sensitized children with eczema.     

Tacrolimus immunosuppression - an association with asymptomatic eosinophilia and elevated total and specific IgE levels

De novo development of food allergy is an infrequent but potentially serious complication of transplantation. An increased prevalence of food allergy noted specifically in children receiving tacrolimus immunosuppression supports the hypothesis that selective suppression of Th1 lymphocytes by the IL-2 inhibitor immunosuppressants CsA, and the more potent drug, tacrolimus , promotes Th2 lymphocytes and an allergic immune response. This study was undertaken to characterize the IgE-mediated immune response, in CsA and tacrolimus-treated, post-OLT children. Thirty children and adolescents aged 1.9-21 yr, mean: 10.6 yr, (6.4 yr post-tx.) were studied. Immunosuppression-CsA: 10 patients, tacrolimus; 20 patients. Blood eosinophils, total IgE levels and specific IgE antibodies (Immulite 2000 Allergy; Diagnostic Products Corp., Los Angeles, CA, USA) to a panel of food and inhaled allergens were measured and correlated with clinical symptoms of allergy. Eosinophilia (>500/mm(3)) range: 599-3125, mean: 1294, was present in 10/20 of patients treated with tacrolimus and 1/10 treated with CsA. IgE levels were elevated in eight of these 10 tacrolimus-treated patients and in two CsA patients ; five were <3 yr of age and IgE levels ranged from 54 to 111 IU/mL (mean: 83), normal for age <45 IU/mL and five were > or =9 yr and IgE levels ranged from 134 to 1606 IU/mL (mean: 557), normal for age <87 IU/mL. Specific IgE levels to a wide panel of food allergens were positive in five tacrolimus-treated patients and to both food and inhaled allergens in three patients (two tacrolimus-treated, one CsA). Four children (tacrolimus-treated) had symptoms of food allergy . None had a family history of allergy. Eosinophilia is present in up to 50% of children and adolescents receiving tacrolimus immunosuppression. The majority of these patients also have elevated levels of total and specific (mainly to food allergens) IgE antibodies. Most patients are asymptomatic and do not manifest food allergy or asthma.     

The prevalence of allergic diseases in an unselected group of 6-year-old children. The DARC birth cohort study

This study determines the prevalence of atopic dermatitis, asthma, rhinoconjunctivitis, food hypersensitivity and urticaria and the frequency of sensitization in children with and without clinical allergic disease. In an ongoing prospective non-interventional birth cohort study of 562 unselected children, 404 children were subjected to interview, clinical examination, lung function measurements and allergy testing at 6 yr of age. Sensitization measured by skin prick test (SPT) and specific immunoglobulin E (S-IgE) was determined for 24 different allergens. The 1-yr period prevalence of atopic dermatitis, asthma and rhinoconjunctivitis was 14.4%, 6.2% and 13.6%. 25.7% of the children suffered from at least one of the three diseases. The frequency of sensitization in children with no disease (controls), any allergic disease, atopic dermatitis, asthma and rhinoconjunctivitis was 17%, 45%, 47%, 56% and 55% (defined as SPT ≥3 mm and/or S-IgE ≥0.35 kU/l for at least one allergen). Symptoms were linked to sensitization for 44% in the asthma group and 42% in the rhinoconjunctivitis group, whereas sensitization could not be linked to worsening of the eczema in any cases of atopic dermatitis. Overlap between the three diseases was significantly more frequent in sensitized children than in non-sensitized (19/46 = 41% vs. 9/58 = 16%, p = 0.004). The prevalence of food hypersensitivity and urticaria was 1.2% and 5.4% respectively. In unselected 6 yr old children, approximately half of the children with atopic dermatitis, asthma or rhinoconjunctivitis are IgE-sensitized. Sensitization tends to link these diseases to each other.     

Probiotic effects on faecal inflammatory markers and on faecal IgA in food allergic atopic eczema/dermatitis syndrome infants

Probiotic bacteria are proposed to alleviate intestinal inflammation in infants with atopic eczema/dermatitis syndrome (AEDS) and food allergy. In such infants we investigated effects of probiotic bacteria on faecal IgA, and on the intestinal inflammation markers tumour necrosis factor-alpha (TNF-alpha), alpha1-antitrypsin (AT), and eosinophil cationic protein (ECP). A total of 230 infants with AEDS and suspected cow's milk allergy (CMA) received in a randomized double-blinded manner, concomitant with elimination diet, Lactobacillus GG (LGG), a mixture of four probiotic strains (MIX), or placebo for 4 wk. Four weeks after treatment, CMA was diagnosed with a double-blind placebo-controlled milk challenge. Faecal samples of 102 infants, randomly chosen for analysis, were collected before treatment, after 4-wk treatment, and on the first day of milk challenge. After treatment, IgA levels tended to be higher in probiotic groups than in the placebo group (LGG vs. placebo, p=0.064; MIX vs. placebo, p=0.064), and AT decreased in the LGG group, but not in other treatment groups. After challenge in IgE-associated CMA infants, faecal IgA was higher for LGG than for placebo (p=0.014), and TNF-alpha was lower for LGG than for placebo, but non-significantly (p=0.111). In conclusion, 4-wk treatment with LGG may alleviate intestinal inflammation in infants with AEDS and CMA.     

Ten-year prognosis for generalized infantile eczema

Forty children treated in our hospital for generalized infantile eczema were re-examined at 11-13 years of age. In 7 (18%) children the eczema had disappeared and in 26 (65%) it had become less severe. Unrelated to dermatological status or gender, allergic rhinitis was diagnosed in 31 (78%) and asthma in 21 (53%) children. Only 8 children continued without either of these two conditions. All 32 children with allergic rhinitis and/or asthma showed at least one positive skin test reaction in a test panel of 11 common inhalant and food allergens compared with only 4 of 8 children without either allergic rhinitis or asthma (p < 0.001). Our results showed an improvement of dermatological status in most children with generalized infantile eczema but there was a high risk of a concomitant respiratory allergy and development of allergic rhinitis or asthma.     

High prevalence of sensitization to aeroallergens in children 4 yrs of age or younger with symptoms of allergic disease

The assumption that sensitization to aeroallergens is rare in preschool children is based on population studies in which most subjects have little or no symptoms of atopic disease. We assessed the prevalence of atopic sensitization in children 0 to 4 yr of age presenting with symptoms of allergic disease by reviewing results of all specific immunoglobulin (IgE) tests performed in our hospital laboratory in children 4 yr of age or younger between 1985 and 2003. Tests were ordered by general practitioners or hospital‐based pediatricians in children presenting with symptoms of allergic disease. Specific IgE tests to a panel of common food and inhalant allergens were performed in 2946 children; a specific IgE concentration >0.35 kU/l was considered positive. Overall, 505 (17%) tests were positive to aeroallergens: 346 (12%) for house dust mite, 257 (9%) for dog dander, 240 (8%) for cat dander, and 197 (7%) for grass pollen. Positive tests were more common in boys (19.2%) than in girls (14.2%, p < 0.01), irrespective of age. Although sensitization to food allergens was more common in 0‐<3 yr olds, aeroallergen and food allergen showed comparable prevalence rates in 3‐<5 yr olds. Sensitization to aeroallergens is common in preschool children with symptoms of allergic disease, and more common in boys than in girls. Screening tests for allergy in infants and toddlers should include inhalant allergens.     

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??There is strong evidence implicating the intestinal flora disturbance in developing allergicdisease including allergic rhinoconjunctivitis??asthma??eczema and food allergy. Experimental studies with animal model of allergy have shown that probiotics can improve allergic manifestations by induceing immune regulation Treg cell??inhibiting the secretion of allergen-induced IgE and Th2 cytokines??attenuating eosinophils infiltration and allergic inflammation in target organs. Probiotics have been proved effective in treatment of IgE-mediated eczema;however??because of the conflicting results??probiotics are recommended for prevention of allergy only in populations at high risk of allergy.     

The association between early sensitization patterns and subsequent allergic disease. The DARC birth cohort study

Prevention of allergic diseases depends on early identification of clinical markers preceding such disorders. This study describes the natural course of sensitization as measured by skin prick test (SPT) and specific immunoglobulin E (S‐IgE) and analyses the association between early sensitization patterns and subsequent allergic disease at 6 yr of age. In an ongoing population‐based birth cohort study of 562 children, follow‐up visits were performed at 0, 3, 6, 9, 12, 18, 36, and 72 months. Visits included an interview, physical examination, SPTs, and S‐IgE measurements for 12 food and inhalant allergens. The frequency of S‐IgE sensitization to ≥1 inhalant allergen was constant from 0 to 6 months (9–10%), decreased at 12–18 months before increasing from 36 months onwards. S‐IgE sensitization to at least one food allergen remained constant from 0 to 6 yr. SPT sensitization to food and inhalant allergens appeared from 3 and 12 months, respectively. Early food sensitization (S‐IgE) between 3 and 18 months was found to be significantly (p < 0.05) associated with atopic dermatitis (OR: 4.0 [1.6–9.9]) and asthma (OR 4.0 [1.1–12.5]) at the age of 6 yr. Children with atopic dermatitis, asthma, or rhinoconjunctivitis, and sensitization at 6 yr, were sensitized to food allergens to a large extent (53%, 42%, and 47%, respectively) already at 6 months. Early inhalant sensitization (S‐IgE) did not increase the risk of later allergic disease. Early atopic dermatitis (0–18 months) was also highly associated with subsequent allergic disease. Children with early food sensitization and/or atopic dermatitis would be a proper target group for future interventional studies.     

Food allergy and atopic dermatitis in infancy: an epidemiologic study

Atopic dermatitis is common in infancy. The role of food allergy in atopic dermatitis of infancy is unclear. We examined the relationship between atopic dermatitis and immunoglobulin E (IgE)-mediated food allergy in infancy. A birth cohort of 620 infants with a family history of eczema, asthma, hayfever or immediate food allergy in a parent or sibling: 487 children had complete data including skin prick tests (SPTs) to evaluate IgE-mediated food allergy to cow milk, egg and peanut. Participants were grouped as no atopic dermatitis (Gp 0) or in quartiles of increasing severity of atopic dermatitis (Gps 1-4) quantified by days of topical steroid use as reported monthly. Adverse reactions to foods were recorded. The cumulative prevalence of atopic dermatitis was 28.9% to 12 months (10.3% of the cohort of moderate severity). As atopic dermatitis severity increased so did the prevalence of IgE-mediated food allergy (Gp 0, 40/346 vs. Gp 1, 6/36 vs. Gp 2, 8/35 vs. Gp 3, 12/35 vs. Gp 4, 24/35; chi(2) = 76; p < 10(-6)), and the frequency of reported adverse food allergy reactions (Gp 0, 43/346 vs. Gp 1, 4/36 vs. Gp 2, 8/35, vs. Gp 3, 5/35, vs. Gp 4, 13/35; chi(2) = 17; p = 0.002). The relative risk of an infant with atopic dermatitis having IgE-mediated food allergy is 5.9 for the most severely affected group. Atopic dermatitis is common in infancy. There is a strong association between IgE-mediated food allergy and atopic dermatitis in this age group.     

Atopy patch testing in children with asthma and rhinitis symptoms allergic to house dust mite

The atopy patch test (APT) is generally used to assess immunoglobulin E (IgE) mediated sensitization to allergens in patients with atopic dermatitis, but its diagnostic role in children with respiratory allergy is still controversial. The aim of the study was to evaluate APT with house dust mite (HDM) in children with asthma and rhinitis symptoms allergic to HDM and its relevance to skin prick test (SPT) diameters and specific IgE levels. The study population consisted of 33 children, aged 8-16 yr (median: 12 yr) with asthma and 30 children with allergic rhinitis in the same age range (median: 11 yr). All patients had positive SPT results and high serum specific IgE levels for Dermatophagoides pteronyssinus APT was performed on back skin of all patients with 200 index of reactivity (IR)/ml of D. pteronyssinus allergen extracts in petrolatum (Stallerpatch) and evaluated at 72 h. Of 63 patients, 16 (25%) showed a positive patch test result. APT with HDM showed 30% (10/33) positivity among the patients with asthma and 20% (6/30) positivity among the patients with allergic rhinitis. APT presented no significant correlation with age, SPT diameter, serum total and specific IgE levels for D. pteronyssinus, nasal provocation test or pulmonary function test results. Patch testing with HDM may partly identify mite sensitive children with respiratory allergy. Positive APT results may imply that delayed hypersensitivity reactions play a role in children with asthma and rhinitis allergic to HDM.