- Open Access
Skin prick test to foods in childhood atopic eczema: pros and cons
© Caffarelli et al.; licensee BioMed Central Ltd. 2013
Received: 11 March 2013
Accepted: 2 May 2013
Published: 31 July 2013
Skin prick tests are the first investigation in allergy diagnostics and their use is described in all the guidelines on atopic eczema. However, the clinical usefulness of skin prick tests is the subject of great debate. On the one hand, skin prick tests allow the identification both of individuals at risk for food allergy and of the allergen inducing the eczematous flare. On the other hand, when performed by a non-specific specialist, positive skin prick tests to foods may wrongly lead to prolonged elimination diets, which may induce nutritional deficiencies and perhaps loss of tolerance to the avoided foods. Furthermore, skin prick tests increase health costs. A consensus on this topic has not yet been reached. Considering the diversity of clinical stages in which it occurs, atopic eczema presentation should be the starting point to determine whether or not skin prick tests should be carried out.
Childhood atopic eczema (AE) is a common chronic inflammatory skin disease. Whether food allergens play a pathogenetic role in inducing exacerbations of AE is a longstanding matter of debate. Some clinicians consider AE to be strongly related to food allergy and perhaps healed by food avoidance [1–3], but others substantially deny such a relationship , limiting investigations for food allergy to severe cases in infancy who do not respond to treatment . Clinical history may provide useful hints to suspect the offending food, even if parents generally overestimate the frequency of food reactions . IgE tests are performed to identify causative food allergens, but the ultimate mean for ascertaining food allergy is the oral provocation challenge. Among the tests used in clinical practice for detecting IgE-mediated sensitivity, skin prick tests (SPTs) are commonly performed as the first step since they are easy to do, cause almost no trauma to the infant or child, are less expensive compared with serum specific IgE (sIgE) antibodies and the results are quickly ready to support the possible diagnosis of IgE-mediatd food allergy [7–9]. Furthermore, it has been found that negative SPT results exclude immediate reactions to the suspected food . A wheal diameter for common foods above certain levels has been proposed to make oral food challenge unnecessary because it has a high positive predictive value [10, 11].
During oral food challenge, exacerbations of AE can be delayed up to several hours or even days after ingestion of the relevant food, suggesting a non IgE-mediated mechanism [12, 13]. Therefore, it is controversial whether SPTs are useful for diagnosing or screening allergy in children with AE.
Pros and cons of executing skin prick test for food allergens in children affected by atopic eczema
Pros of executing SPT
Cons of executing SPT
• Identification of triggers of flare
• Lack of standardized skin prick test technique
• Diagnosis of associated clinical hypersensitivity reactions to foods
• Dietary restrictions based only on SPT results leading to:
- loss of tolerance
• Prediction of reaction at first ingestion of egg and peanuts
- nutritional problems
• Younger children
• Mild disease
• Moderate-to-severe disease
• Not specific for the diagnosis of AE
• Recognition of children at risk for respiratory atopic diseases
• Increase health cost
Pros of executing SPT in children with AE
Several advantages have been attributed to SPT execution over non-execution: detection of children with associated food allergy, identification of foods causing AE flares, screening of children at risk for clinical hypersensitivity reactions to food, early identification of patients at risk for allergic respiratory disease (Table 1).
Detection of foods that exacerbate AE
There is some evidence that, in a subgroup of patients, eczematous lesions can be significantly worsened by food intake. After an oral food challenge, some children develop a rapid-onset itchy rash, either isolated or as part of a systemic reaction [12, 13]. Other children may present a flare of AE some hours or days later [12, 13], which may be isolated in about 12% of instances or preceded by a non eczematous immediate reaction in 45% of cases . Moreover, it has been noted that AE improves when the foods responsible for immediate reactions are eliminated from the diet . For instance, when hen’s egg is avoided in children with positive sIgE to egg, AE improves .
Taking into consideration that AE improves with age and allergy to the most common allergenic foods in infants (cow’s milk and hen’s egg) is often outgrown during childhood , SPT to food may be less helpful beyond infancy. However, in older children as well as in adults there are some reports that there is a late-onset exacerbation of AE following challenge with birch pollen-related foods [15, 16].
In the diagnostic work-up for identifying foods that are responsible of eczematous flare-up, history is often unreliable and SPT diagnostic accuracy is low [12, 17]. The improvement of skin symptoms following an elimination diet is not enough to ascertain that a particular food is the culprit of AE. Oral provocation challenge remains the standard for the diagnosis [12, 18–22]. When no immediate reactions are observed, the administration of the food should be continued for at least two days.
Identification of eczematous children with associated food allergy
In 40% to 90% of eczematous children, tests for IgE-mediated hypersensitivity to foods result as positive [23–25]. However, a positive SPT does not mean that the child has a clinical immediate hypersensitivity to that food. Any positive IgE test to foods is irrelevant if not in agreement with a possible clinical history and confirmed by an oral provocation test. This is warranted not only to prevent possibly harmful reactions, but also to avoid useless diets. The latter point is of particular importance when the implicated food is essential for nutrition, such as cow’s milk in very young babies. Positive IgE tests to foods confirmed by the onset of immediate reactions upon oral food challenge have been reported in 30–60% of children with AE [13, 17, 26], mostly in the case of moderate-to-severe AE [27–30]. An oral food challenge is not necessary when a positive SPT to a specific food is associated with a clear-cut history of an anaphylactic reaction to that food. In food-dependent exercise-induced anaphylaxis, SPT is helpful in identifying foods whose intake before physical exercise might provoke an anaphylactic reaction [31, 32].
Screening of children at risk for immediate reactions to food
Children with a positive SPT to hen’s egg  or peanuts  and who had never previously ingested these foods are at risk for immediate reactions at the first intake. On the other hand, a negative SPT result to a food is useful to exclude with high accuracy that the child will not have immediate reactions to its intake .
Early identification of patients at risk for allergic respiratory disease
Atopic sensitization and the development of allergic asthma and/or rhinitis is very common among AE patients, and its early detection and prevention are a major part of AE global management [1, 9]. It has been shown that infants with the early development of IgE sensitization to food allergens have an increased risk for later development of inhalant sensitization in childhood [35, 36]. In children with AE a positive SPT results to egg at 1 year of age was associated with subsequent asthma at 4 years of age  and of respiratory atopic diseases such as rhinoconjunctivitis and asthma at 6 years of age [38–40]. On the other hand, house dust mites allergy is considered, per se, to be an aggravating factor in AD patients, becoming increasingly relevant during chidhood and adolescence.
Cons of executing SPT in children with AE
There are some arguments suggesting that not carrying out SPT is better than executing them in children with AE. These points mainly include poor SPT standardization, long elimination diets with a subsequent risk of severe reactions because of loss of tolerance to the avoided foods and high health costs (Table 1).
Lack of standardized SPT technique
Most commercially available food allergen extracts for SPT as well as the technique for skin testing are not standardized . Food reagents are usually classified according to weight by volume in the absence of characterization of potency, allergenic molecules, or protein content . Therefore, sensitivity of food extracts may vary from company to company . Serum food sIgE levels obtained by different assays are not equivalent, too . Thus, published data on the diagnostic accuracy of SPT or sIgE antibodies to foods should be considered only relevant for that study and hardly comparable with the results of other studies. Skin testing with fresh food seems to enhance sensitivity  and specificity . SPT with molecular food allergen may have increased sensibility. However, studies comparing SPTs with food extracts and those with natural foods or with allergen components in children with AE are warranted to extend previous findings. Such studies should take into account that many patients who have allergic reactions to fresh foods can tolerate the same food when it is cooked or baked .
Dietary restrictions in children with AE
There are some old low-quality studies supporting the efficacy of an exclusion diet in unselected patients with AE . When the diet was effective, SPT reactions were not useful to predict which children would have had an improvement of the skin lesions . Overall, a cost/benefit analysis suggests that it is not recommended to perform SPT in children with mild-to-moderate AE and on a non-restriction diet .
Another issue is that, when SPT results show a sensitization against one or more foods in children with AE, elimination of these foods from the child’s diet is often carried on for several months before the patient is referred for oral food challenge. Only a short-term (no more than 2–3 weeks) diet, with a subsequent intake of the food in order to ascertain its etiologic role, is acceptable. Some cases have been reported in which, after a long period of exclusion diet, children affected by AE had anaphylactic reactions to cow’s milk that had never occurred previously [50, 51], suggesting that the diet itself might have favored the loss of immunologic tolerance and the onset of food allergy. This implies that, under these circumstances, the reintroduction of the food should be always planned in a hospital setting, despite the inconveniences for children or parents and the costs for the structure.
Another problem is that children on a prolonged diet might undergo nutritional deficiencies, including failure to thrive and kwashiorkor  when they are not supervised by a dietitian.
AE diagnosis and clinical course
No specific marker for the diagnosis of AE has been reported. The diagnosis mainly relies on a combination of clinical features . Positive SPT results are listed by Hanifin and Rajka  among the minor criteria for AE diagnosis. However, there is no evidence that positive SPT can play a role for this diagnosis . The sensitization to food allergens can follow the occurrence of AE, but can also precede and predict AE onset . It is unclear whether the number of positive SPT results is associated with AD severity [29, 55, 57–62] Contrasting data have been provided also on the association between sensitization and AE persistence [60, 61].
Longitudinal studies have shown that early long-term sensitization may be associated with more severe AE .
AE therapy is based on the use of emollients and topical or, less frequently systemic corticosteroids. There is evidence that, in a subgroup of patients, foods can trigger late onset eczematous flares. Elimination of identified food allergens has been shown to provide improvement of AE symptoms, but combined with good skin care and pharmacotherapy when needed. AE, however, has causes that are also not related to food allergies. Patients who respond well to skin care treartment with minimal topical steroids treatment are not likely to benefit from dietary intervention when no history of immediate food allergic reactions are reported.
In children with AE, SPT for foods can be proposed to detect an IgE-mediated sensitization to foods and predict the risk of immediate reactions after their ingestion. A short-term diet and a well-defined reintroduction plan should be offered. A prolonged elimination diet should be followed only for foods which have been demonstrated by oral challenge to be responsible for adverse reactions.
A number of matters continue to be unclear. Are SPTs with fresh food or molecular allergens useful in identifying children with AE flare-up caused by foods? To what extent can the evidence obtained by AE improvement in infants following an elimination diet be transferred to different age groups? Further studies are necessary to clarify the unmet needs of SPTs to foods in children with atopic eczema, namely the prediction of response to elimination diet in different age group children, the identification of foods which exacerbate AE, the diagnostic accuracy of SPT with fresh foods, extracts or allergen components, and the performance of cost-effectiveness studies.
Finally, we believe that the results of SPT in young children with AE may be helpful in identifying or excluding an associated food allergy and in recognizing which patients have an atopic background and thus require a follow up also targeted to the early detection and prevention of allergic asthma and/or rhinitis. SPT results should not be interpreted by a physician who was not trained in allergy as inaccurate clinical practice may lead to prolonged and potentially harmful restriction diets.
- Darsow U, Wollenberg A, Simon D, Taïeb A, Werfel T, Oranje A, Gelmetti C, Svensson A, Deleuran M, Calza AM, Giusti F, Lübbe J, Seidenari S, Ring J, European Task Force on Atopic Dermatitis/EADV Eczema Task Force: ETFAD/EADV eczema task force 2009 position paper on diagnosis and treatment of atopic dermatitis. J Eur Acad Dermatol Venereol. 2010, 24: 317-328. 10.1111/j.1468-3083.2009.03415.x.View ArticlePubMedGoogle Scholar
- Rancé F, Boguniewicz M, Lau S: New visions for atopic eczema: an iPAC summary and future trends. Pediatr Allergy Immunol. 2008, 19 (Suppl 19): 17-25.View ArticlePubMedGoogle Scholar
- Greenhawt M: The role of food allergy in atopic dermatitis. Allergy Asthma Proc. 2010, 31: 392-397. 10.2500/aap.2010.31.3393.View ArticlePubMedGoogle Scholar
- de Bruin Weller MS, Knulst AC, Meijer Y, Bruijnzeel-Koomen CAFM, Pasmans SGM: Evaluation of the child with atopic dermatitis. Clin Exp Allergy. 2012, 42: 352-362. 10.1111/j.1365-2222.2011.03899.x.View ArticlePubMedGoogle Scholar
- Williams HC: Atopic dermatitis. N Engl J Med. 2005, 352: 2314-2324. 10.1056/NEJMcp042803.View ArticlePubMedGoogle Scholar
- Caffarelli C, Coscia A, Ridolo E, Povesi Dascola C, Gelmetti C, Raggi V, Volta E, Vanelli M, Vanelli M: Parents’ estimate of food allergy prevalence and management in Italian school-aged children. Pediatr Int. 2011, 53: 505-510. 10.1111/j.1442-200X.2010.03294.x.View ArticlePubMedGoogle Scholar
- Caffarelli C, Baldi F, Bendandi B, Calzone L, Marani M, Pasquinelli P, on behalf of EWGPAG: Cow’s milk protein allergy in children: a practical guide. Ital J Pediatr. 2010, 36: 5-10.1186/1824-7288-36-5.PubMed CentralView ArticlePubMedGoogle Scholar
- Sampson HA, Albergo R: Comparison of results of skin tests, RAST and double-blind, placebo-controlled food challanges in children with atopic dermatitis. J Allergy Clin Immunol. 1984, 74: 26-33. 10.1016/0091-6749(84)90083-6.View ArticlePubMedGoogle Scholar
- Lipozenčic J, Wolf R: The diagnostic value of atopy patch testing and prick testing in atopic dermatitis: facts and controversies. Clinics in Dermatology. 2010, 28: 38-44. 10.1016/j.clindermatol.2009.03.008.View ArticlePubMedGoogle Scholar
- Sporik R, Hill DG, Hosking CS: Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children. Clin Exp Allergy. 2000, 30: 1540-1546.View ArticlePubMedGoogle Scholar
- Mehl A, Rolinck-Werninghaus C, Staden U: The atopy patch test in the diagnostic workup of suspected food-related symptoms in children. J Allergy Clin Immunol. 2006, 118: 923-929. 10.1016/j.jaci.2006.07.003.View ArticlePubMedGoogle Scholar
- Breuer K, Hetatizadeh A, Wulf A, Baumann U, Constien A, Tetau D: Late eczematous reactions to food in children with atopic dermatitis. Clin Exp Allergy. 2004, 34: 817-824. 10.1111/j.1365-2222.2004.1953.x.View ArticlePubMedGoogle Scholar
- Burks AW, Mallory SB, Williams LW, Shirrell MA: Atopic dermatitis: clinical relevance of food hypersensitivity reactions. J Pediatr. 1988, 113: 447-45. 10.1016/S0022-3476(88)80626-7.View ArticlePubMedGoogle Scholar
- Lever R, MacDonald C, Waugh P, Aitchison T: Randomised controlled trial of advice on an egg exclusion diet in young children with atopic eczema and sensitivity to eggs. Pediatr Allergy Immunol. 1998, 9: 13-19. 10.1111/j.1399-3038.1998.tb00294.x.View ArticlePubMedGoogle Scholar
- Breuer K, Wulf A, Constien A, Tetau D, Kapp A, Werfel T: Birch pollen-related food as a provocation factor of allergic symptoms in children with atopic eczema/dermatitis syndrome. Allergy. 2004, 59: 988-994. 10.1111/j.1398-9995.2004.00493.x.View ArticlePubMedGoogle Scholar
- Reekers R, Busch M, Whittmann M, Kapp A, Werfel T: Birch pollen-related foods trigger atopic dermatitis in patients with specific cutaneous T-cell responses to birch pollen antigens. J Allergy Clin Immunol. 1999, 104: 466-472. 10.1016/S0091-6749(99)70395-7.View ArticlePubMedGoogle Scholar
- Atherton DJ, Sewell M, Soothill JF, Wells RS, Chilvers CE: A double-blind controlled crossover trial of an antigen-avoidance diet in atopic eczema. Lancet. 1978, 1: 401-403.View ArticlePubMedGoogle Scholar
- Nowak-Wegrzyn A, Assa’ad AH, Bahna SL, Bock SA, Sicherer SH, SS Work Group report: Oral food challenge testing. J Allergy Clin Immunol. 2009, 123: S365-S383. 10.1016/j.jaci.2009.03.042.View ArticlePubMedGoogle Scholar
- Sampson HA, van Wijk RG, Bindslev-Jensen C, Sicherer SH, Teuber SS, Burks AW, Dubois AEI, Beyer K, Eigenmann PA, Spergel JM, Werfel T, Chinchilli VM: Standardizing double-blind, placebo-controlled oral foodchallenges: American Academy of Allergy, Asthma & Immunology–European Academy of Allergy and Clinical Immunology PRACTALL consensus report. J Allergy Clin Immunol. 2012, 130: 1260-1274. 10.1016/j.jaci.2012.10.017.View ArticlePubMedGoogle Scholar
- Bindslev-Jensen C, Ballmer-Weber BK, Bengtsson U: Standardization of food challenges in patients with immediate reactions to foods – position paper from the European Academy of Allergology and Clinical Immunology. Allergy. 2004, 59: 690-697. 10.1111/j.1398-9995.2004.00466.x.View ArticlePubMedGoogle Scholar
- Caffarelli C, Petroccione T: False-negative food challenge in children with suspected food allergy. Lancet. 2001, 358: 1871-1872. 10.1016/S0140-6736(01)06897-0.View ArticlePubMedGoogle Scholar
- Caffarelli C, Ricò S, Rinaldi L, Povesi Dascola C, Terzi C, Bernasconi S: Blood pressure monitoring in children undergoing food challenge: association with anaphylaxis. Ann Allergy Asthma Immunol. 2012, 108: 285-286. 10.1016/j.anai.2012.02.001.View ArticlePubMedGoogle Scholar
- Johnke H, Norberg LA, Vach W, Host A, Andersen KE: Patterns of sensitization in infants and its relation to atopic dermatitis. Pediatr Allergy Immunol. 2006, 17: 591-600. 10.1111/j.1399-3038.2006.00453.x.View ArticlePubMedGoogle Scholar
- Lever R: The role of food in atopic eczema. J Am Acad Dermatol. 2001, 45: 57-60. 10.1067/mjd.2001.117012.View ArticleGoogle Scholar
- Rennick GJ, Moore E, Orchard DC: Skin prick testing to food allergens in breast-fed young infants with moderate to severe atopic dermatitis. Australas J Dermatol. 2006, 47: 41-45. 10.1111/j.1440-0960.2006.00221.x.View ArticlePubMedGoogle Scholar
- Eigenmann PA, Sicherer SH, Borkowski TA, Cohen BA, Sampson HA: Prevalence of IgE mediated food allergy among children with atopic dermatitis. Pediatrics. 1998, 101: 8-View ArticleGoogle Scholar
- Bock SA: Diagnostic evaluation. Pediatrics. 2003, 111: 1638-1644.PubMedGoogle Scholar
- Burks AW, James JM, Hiegel A, Wilson G, Wheeler JG, Jones SM, Zuerlein N: Atopic dermatitis and food hypersensitivity reactions. J Pediatr. 1998, 132: 132-136. 10.1016/S0022-3476(98)70498-6.View ArticlePubMedGoogle Scholar
- Guillet G, Guillet MH: Natural history of sensitizations in atopic dermatitis. A 3-year follow-up in 250 children: food allergy and high risk of respiratory symptoms. Arch Dermatol. 1992, 128: 187-192. 10.1001/archderm.1992.01680120059004.View ArticlePubMedGoogle Scholar
- Hill DJ, Hosking CS: Food allergy and atopic dermatitis in infancy: an epidemiologic study. Pediatr Allergy Immunol. 2004, 15: 421-427. 10.1111/j.1399-3038.2004.00178.x.View ArticlePubMedGoogle Scholar
- Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, Plaut M, Cooper SF, Fenton MJ, Arshad SH, Bahna SL, Beck LA, Byrd-Bredbenner C, Camargo CA, Eichenfield L, Furuta GT, Hanifin JM, Jones C, Kraft M, Levy BD, Lieberman P, Luccioli S, McCall KM, Schneider LC, Simon RA, Simons FE, Teach SJ, Yawn BP, Schwaninger JM: Guidelines for the diagnosis and management of food allergy in the united states: Report of the NIAID-Sponsored Expert Panel. J Allergy Clin Immunol. 2010, 126: S1-S58.PubMed CentralView ArticlePubMedGoogle Scholar
- Povesi Dascola C, Caffarelli C: Exercise-induced anaphylaxis: a clinical view. Ital J Ped. 2012, 38: 43-10.1186/1824-7288-38-43.View ArticleGoogle Scholar
- Caffarelli C, Cavagni G, Giordano S, Stapane I, Rossi C: Relationship between oral challenges with previously uningested egg and egg-specific IgE antibodies and skin prick tests in infants with food allergy. J Allergy Clin lmmunol. 1995, 951: 15-20.Google Scholar
- Johannsen H, Nolan R, Pascoe EM, Cuthbert P, Noble V, Corderoy T, Franzmann A, Loh R, Prescott SL: Skin prick testing and peanut-specific IgE can predict peanut challenge outcomes in preschool children with peanut sensitization. Clin Exp Allergy. 2011, 41: 994-1000. 10.1111/j.1365-2222.2011.03717.x.View ArticlePubMedGoogle Scholar
- Rhodes HL, Thomas P, Sporik R, Holgate ST, Cogswell JJ: A birth cohort study of subjects at risk of atopy: twenty-two-year follow-up of wheeze and atopic status. Am J Respir Crit Care Med. 2002, 15: 176-180.View ArticleGoogle Scholar
- Dean T, Venter C, Pereira B, Harsad HS, Grundy J, Clayton BC, Higgins B: Patterns of sensitization to food and aeroallergens in the first 3 years of life. J Allergy Clin Immunol. 2007, 120: 1166-1171. 10.1016/j.jaci.2007.06.042.View ArticlePubMedGoogle Scholar
- Tariq SM, Matthews SM, Hakim EA, Arshad SH: Egg allergy in infancy predicts respiratory allergic disease by 4 years of age. Pediatr Allergy Immunol. 2000, 11: 162-167. 10.1034/j.1399-3038.2000.00077.x.View ArticlePubMedGoogle Scholar
- Burr ML, Merrett TG, Dunstan FD, Maguire MJ: The development of allergy in high-risk children. Clin Exp Allergy. 1997, 27: 1247-1253. 10.1111/j.1365-2222.1997.tb01168.x.View ArticlePubMedGoogle Scholar
- Lowe AJ, Hosking CS, Bennett CM: Skin prick test can identify eczematous infants at risk of asthma and allergic rhinitis. Clin Exp Allergy. 2007, 37: 1624-1631. 10.1111/j.1365-2222.2007.02822.x.View ArticlePubMedGoogle Scholar
- Kjaer HF, Eller E, Andersen KE, Høst A, Bindslev-Jensen C: The association between early sensitization patterns and subsequent allergic disease. The DARC birth cohort study. Pediatr Allergy Immunol. 2009, 20: 726-734. 10.1111/j.1399-3038.2009.00862.x.View ArticlePubMedGoogle Scholar
- Bernstein IL, Li JT, Bernstein DI, Hamilton R, Spector SL, Tan R, Sicherer S, Golden DB, Khan DA, Nicklas RA, Portnoy JM, Blessing-Moore J, Cox L, Lang DM, Oppenheimer J, Randolph CC, Schuller DE, Tilles SA, Wallace DV, Levetin E, Weber R, American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology: Allergy diagnostic testing: an updated practice parameter. Ann Allergy Asthma Immunol. 2008, 100 (Suppl. 3): S1-S148.Google Scholar
- Bernhisel-Broadbent J: Allergenic cross-reactivity of foods and characterization of food allergens and extracts. Ann Allergy Asthma Immunol. 1995, 75: 295-303.PubMedGoogle Scholar
- Sampson HA: Comparative study of commercial food antigen extracts for the diagnosis of food hypersensitivity. J Allergy Clin Immunol. 1988, 82: 718-726. 10.1016/0091-6749(88)90070-X.View ArticlePubMedGoogle Scholar
- Wang J, Godbold JH, Sampson HA: Correlation of serum allergy (IgE) tests performed by different assay systems. J Allergy Clin Immunol. 2008, 121: 1219-1224. 10.1016/j.jaci.2007.12.1150.View ArticlePubMedGoogle Scholar
- Rosen J, Selcow J, Mendelson L, Grodofsky M, Factor J, Sampson H: Skin testing with natural foods in patients suspected of having food allergies.is it necessary?. J Allergy Clin Immunol. 1994, 93: 1068-1070. 10.1016/S0091-6749(94)70056-7.View ArticlePubMedGoogle Scholar
- Alessandri C, Zennaro D, Scala E, Ferrara R, Bernardi ML, Santoro M, Palazzo P, Mari A: Ovomucoid (Gal d 1) specific IgE detected by microarray system predict tolerability to boiled hen’s egg and an increased risk to progress to multiple environmental allergen sensitization. Clin Exp Allergy. 2011, 42: 441-450.View ArticlePubMedGoogle Scholar
- Huang F, Nowak-Wegrzyn A: Extensively heated milk and egg as oral immunotherapy. Curr Opin Allergy Clin Immunol. 2012, 12: 283-292. 10.1097/ACI.0b013e3283535bc3.View ArticlePubMedGoogle Scholar
- Bath-Hextall FJ, Delamere FM, Williams HC: Dietary exclusions for established atopic eczema. Cochrane Database of Systematic Reviews. 2008, Issue 1Google Scholar
- Ricci G, Dondi A, Patrizi A: Useful tools for the management of atopic dermatitis. Am J Clin Dermatol. 2009, 10: 287-300. 10.2165/11310760-000000000-00000.View ArticlePubMedGoogle Scholar
- David TJ: Anaphylactic shock during elimination diets for severe atopic dermatitis. Arch Dis Child. 1984, 59: 983-6. 10.1136/adc.59.10.983.PubMed CentralView ArticlePubMedGoogle Scholar
- Flintermann AE, Knulst AC, Meijer Y, Bruijnzeel-Koomen CA, Pasmans SG: Acute allergic reactions in children with AEDS after prolonged cow’s milk elimination diets. Allergy. 2006, 61: 370-374. 10.1111/j.1398-9995.2006.01018.x.View ArticleGoogle Scholar
- Noimark L, Cox HE: Nutritional problems related to food allergy in childhood. Pediatr Allergy Immunol. 2008, 19: 188-195. 10.1111/j.1399-3038.2007.00700.x.View ArticlePubMedGoogle Scholar
- Williams HC, Burney PG, Hay RJ, Archer CB, Shipley MJ, Hunter JJ: The UK Working Party’s Diagnostic Criteria for Atopic Dermatitis. I. Derivation of a minimum set of discriminators for atopic dermatitis. Br J Dermatol. 1994, 131: 383-96. 10.1111/j.1365-2133.1994.tb08530.x.View ArticlePubMedGoogle Scholar
- Hanifin JM, Rajka G: Diagnostic features of atopic dermatitis. Acta Dermatol Venereol. 1980, 92: 44-47.Google Scholar
- Flohr C, Johansson SGO, Wahlgren CF, Williams H: How atopic is atopic dermatitis?. J Allergy Clin Immunol. 2004, 113: 150-8.View ArticleGoogle Scholar
- Lowe AJ, Abramson MJ, Hosking CS, Carlin JB, Bennett CM, Dharmage SC, Hill DJ: The temporal sequence of allergic sensitization and onset of infantile eczema. Clin Exp Allergy. 2007, 37: 536-542. 10.1111/j.1365-2222.2007.02691.x.View ArticlePubMedGoogle Scholar
- Celik-Bilgili S, Mehl A, Verstege A, Staden U, Nocon M, Beyer K, Niggemann B: The predictive value of specific immunoglobulin E levels in serum for the outcome of oral food challenges. Clin Exp Allergy. 2005, 35: 268-73. 10.1111/j.1365-2222.2005.02150.x.View ArticlePubMedGoogle Scholar
- Böhme M, Svensson A, Kull I, Nordvall SL, Wahlgren CF: Clinical features of atopic dermatitis at two years of age: a prospective, population-based case–control study. Acta Derm Venereol. 2001, 81: 193-7. 10.1080/000155501750376294.View ArticlePubMedGoogle Scholar
- Patrizi A, Guerrini V, Ricci G, Neri I, Specchia F, Masi M: The natural history of sensitization to food and aeroallergens in atopic dermatitis: a 4-year follow-up. Pediatr Dermatol. 2000, 17: 261-5. 10.1046/j.1525-1470.2000.01771.x.View ArticlePubMedGoogle Scholar
- Wolkerstorfer A, Wahn U, Kjellman NIM, Diepgen TL, De Longueville M, Oranje AP: Natural course of sensitization to cow’s milk and hen’s egg in childhood atopic dermatitis: ETAC Study Group. Clin Exp Allergy. 2002, 32: 70-3. 10.1046/j.0022-0477.2001.01265.x.View ArticlePubMedGoogle Scholar
- Novembre E, Cianferoni A, Lombardi E, Bernardini R, Pucci N, Vierucci A: Natural history of intrinsic atopic dermatitis. Allergy. 2001, 56: 452-63. 10.1034/j.1398-9995.2001.056005452.x.View ArticlePubMedGoogle Scholar
- Wuthrich B, Schmid-Grendelmeier P: Natural course of AEDS. Allergy. 2002, 57: 267-8. 10.1034/j.1398-9995.2002.1n3572.x.View ArticlePubMedGoogle Scholar
- Eller E, Kjaer HF, Høst A, Andersen KE, Bindslev-Jensen C: Development of atopic dermatitis in the DARC birth cohort. Pediatr Allergy Immunol. 2009, 21: 307-314.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.