O teste de contato (patch test) na avaliação de sensibilização por alimentos em pacientes com dermatite atópica – estudo piloto
Patch testing in the evaluation of food sensitization in patients with atopic dermatitis – a pilot study
Cristiane Momoi; Lucila Camargo Lopes de Oliveira; Marcia Carvalho Mallozi; Renata Rodrigues Cocco; Dirceu Solé
Resumo
Objetivos: Investigar o papel do patch test na avaliação da sensibilização por alimentos e no diagnóstico de alergia alimentar em pacientes com dermatite atópica (DA) e comparar duas distintas apresentações do teste. Métodos: Esse estudo prospectivo envolveu 20 crianças (mediana de idade de 8,4 anos) com dermatite atópica moderada ou grave que foram submetidas ao teste cutâneo de hipersensibilidade tardia (patch test) com alimentos frescos e extratos comerciais, seguidos de teste de provocação oral (TPO) nos casos de resultado positivo, no intuito de avaliar a correlação clínica. Resultados: Entre os 20 pacientes avaliados, somente 4 (20%) apresentaram resultados positivos para o patch test, com maior positividade para os extratos comerciais (3/4), em comparação aos alimentos in natura. Não se observou concordância dos resultados obtidos entre as duas apresentações comparadas. Do total de 7 TPO realizados, 4 foram positivos (soja e milho para um paciente e amendoim para outros dois), com piora das lesões da DA (valor preditivo positivo de 57%). Apenas uma criança apresentou efeito adverso mais significativo. Conclusões: Embora tenha sido encontrada baixa sensibilização aos alérgenos alimentares na população estudada e discordância entre os resultados dos patch tests com alimentos frescos e extratos comerciais, o teste mostrou-se seguro. Para uma melhor análise estatística, recomenda-se estudo em população maior.
Palavras-chave
Abstract
Objective: To evaluate the use of patch testing in determining food sensitization and allergy in patients with atopic dermatitis (AD) and compare two distinct assays. Method: Twenty children (median age, 8.4 years) with moderate-to-severe AD were prospectively evaluated by atopy patch test with commercial extracts and fresh food allergens. Positive results were further investigated by oral food challenge (OFC). Results: Only 4/20 patients (20%) had positive patch results, mostly to commercial extracts (3/4) compared to fresh food. There was no agreement between the results of the two presentations tested. Four of seven OFCs were positive (one patient to soy and corn, two others to peanut), with worsening AD eczema (positive predictive value of 57%). One child had a more significant side effect. Conclusion: In spite of poor sensitization rates in the study population and no observed correlation between the two presentations tested, atopy patch testing was safe. Studies with a broader population are needed for better conclusions.
Keywords
Referências
1. Flohr C, Mann J. New insights into the epidemiology of childhood atopic dermatitis. Allergy. 2014;69:3-16.
2. Hanifin JM, Rajka G. Diagnostic features os atopic dermatitis. Acta Derm Venereol (Stockh). 1980;(Suppl. 92):44-7.
3. European Task Force on Atopic Dermatitis. Severity Scoring of atopic dermatites: The SCORAD Index Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology. 1993;186:23-31.
4. Kunz B, Oranje AP, Labréze L, Stalder JF, Ring J, Taieb A. Clinical validation and guidelines for the SCORAD index: consensus report of the European task Force on Atopic Dermatitis. Dermatology.1997;195:10‑9.
5. Sicherer SH, Sampson HA. Food hypersensitivity and atopic dermatitis: pathophysiology, epidemiology, diagnosis, and management. J Allergy Clin Immunol. 1999;104:S114-S122.
6. Gray CL, Levin ME. Food allergy in atopic dermatitis: how, when and why do we test?. Curr Allergy Clin Immunol. 2014:27(2):82-6.
7. Roehr CC, Reibel S, Ziegert M, Sommerfeld C, Wahn U, Niggemann B. Atopy patch tests, together with determinations of specific IgE levels, reduce the need for oral challenges in children with atopic dermatitis. J Allergy Clin Immunol. 2001;107:548-53.
8. Pereira RA, Cocco RR, Solé D, Mallozi MC, Aranda CS. Teste de contato alérgico (patch test) com alimentos no diagnóstico etiológico da esofagite eosinofílica: útil ou não? Arq Asma Alerg Imunol. 2019;3(1):93-4.
9. Yang H, Xiao YZ, Luo XY, Tan Q, Wang H. Diagnostic accuracy of atopy patch test for food allergy in children with atopic dermatitis aged less than two years. Allergol Immunopathol. 2014;42:22-8.
10. Levy SAP, Junior ADD, Pires AHS, Abe AT, Valle AOR, Coelho VP, et al. Atopy patch test (APT) in the diagnosis of food allergy in children with atopic dermatitis. An Bras Dermatol. 2012;87:724-8.
11. Canani RB, Ruotolo S, Auricchio L, Caldore M, Porcaro F, Manguso F, et al. Diagnostic accuracy of the atopy test in children with food allergy-related gastrointestinal symptoms. Allergy. 2007;62:738‑43.
12. Mehl A, Werninghaus CR, Staden U, Verstege A, Wahn U, Beyer K, et al. The atopy patch test in the diagnostic workup of suspected food-related symptoms in children. J Allergy Clin Immunol. 2006;118(4):923-9.
13 Kalach N, Soulaines P, de Boissieu D, Dupont C. A pilot study of the usefulness and safety of a ready-to-use atopy patch test (Diallertest) versus a comparator (Finn Chamber) during cow´s milk allergy in children. J Allergy Clin Immunol. 2005;116:1321-6.
14. Spergel JM, Beausoleil JL, Mascarenhas M, Liacouras CA. The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol. 2002;109(2):363-8.
15. Niggemann B, Reibel S, Wahn U. The atopy patch test (APT) - a useful tool for the diagnosis of food allergy un children with atopic dermatitis. Allergy. 2000;55:281-5.
16. Rokaite R, Labanauskas L, Vaideliene L. Role of the patch test in diagnosing food allergy in children with atopic dermatitis. Medicina (Kaunas). 2004;40:1081-7.
17. Turjanmaa K, Darsow U, Neggemann B, Rancé F, Vanto T, Werfel T. EAACI/GA2LEN position paper: present status of the atopy patch test. Allergy. 2006;61:1377-84.
18. Langeveld-Wildschut EG, Riedl H, Thepen T, Bihari IC, Bruijnzeel PL, Bruijnzeel-Koomen CA. Modulation of the atopy patch test reaction by topical corticosteroids and tar. J Allergy Clin Immunol. 2000;106(4):737-43.
19. Weissenbacher S, Traidl-Hoffmann C, Eyerich K, Katzer K, Braeutigam M, Loeffler H, et al. Modulation of atopy patch test and skin prick test by Pretreatment with 1% Pimecrolimus cream. Int Arch Allergy Immunol. 2006;140:239-44.
20. Spergel JM, Brown-Whitehorn T. The use of patch testing in the diagnosis of food allergy. Cur Allergy Asthma Rep. 2005;5(1):86‑90.
21. Stromberg L. Diagnostic accuracy of the atopy patch test and the skinprick test for the diagnosis of food allergy in young children with atopic eczema/dermatitis syndrome. Acta Pediatr. 2002;91:1044-9.
22. Werfel T, Ballmer-Weber B, Eigenmann PA, Niggemann B, Rancé F, Turjanmaa K, et al. Eczematous reactions to food in atopic eczema: position paper of the EAACI and GA2LEN. Allergy. 2007;62:723-8.
23. Stromber L. Diagnostic accuracy of the atopy patch test and the skinprick test for the diagnosis of food allergy in young children with atopic eczema/dermatitis syndrome. Acta Paediatr. 2002;91(10):1044-9.
24. Boonyaviwat O, Pacharn P, Jirapongsananuruk O, Vichyanond P, Visitsunthorn N. Role of atopy patch test for diagnosis of food allergy-related gastrointestinal symptoms in children. Pediatr Allergy Immunol. 2015;26(8):737-41.
25. Duarte I, Lazzarini R. Síndrome da pele excitada associada à técnica de aplicação dos testes de contato. An Bras Dermatol. 2005;80(2):S107-8.
26. Heine RG, Verstege A, Mehl A, Staden U, Rolinck-Werninghaus C, Niggemann B. Proposal for a standardized interpretation of the atopy patch test in children with atopic dermatitis and suspected food allergy. Pediatr Allergy Immunol. 2006;17(3):213-7.
Submetido em:
24/06/2019
Aceito em:
28/06/2019
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