Diagnostic tests in children with atopic dermatitis and food allergy

Background Skin testing is a common diagnostic procedure in food allergy. T he skin prick test is the test of first choice for investigating the immedi ate IgE-mediated reaction. The skin application food test (SAFT) has been d eveloped on the basis of the mechanism of the contact urticaria syndrome (C US). Methods We studied the relevance of the SAFT in children younger than 4 yea rs with atopic dermatitis and (suspected) food allergy as compared with the prick-prick test, the radioallergosorbent test (RAST), and the oral challe nge. In the skin tests, we used fresh food, in the same state as it was con sumed. Results There was a good agreement between the SAFT and the prick-prick tes t. A moderate agreement was observed between the SAFT and the serologic tes t (RAST). Significantly more positive results in the RAST were observed tha n in the SAFT. There was very good agreement between the SAFT and the oral challenge (kappa=0.86). Conclusions The SAFT is a reliable and child-friendly skin test for evaluat ing (suspected) food allergy in children younger than 4 years with atopic d ermatitis. The very good correlation with the oral challenge indicates that one may probably consider the SAFT a "skin provocation" in children younge r than 4 years.