Utility of the Atopy Patch Test in the Diagnosis of Allergic Rhinitis

Fuiano, Nicola; Incorvaia, Cristoforo

doi:10.22038/ijorl.2016.6829

Utility of the Atopy Patch Test in the Diagnosis of Allergic Rhinitis

Document Type : Systematic Review

Authors

¹ Pediatric Allergy Service, San Severo, Italy.

² Pulmonary Rehabilitation, ICP Hospital, Via Bignami 1, 20137 Milan, Italy.

10.22038/ijorl.2016.6829

Abstract

Introduction:
The diagnostic work-up of allergic rhinitis (AR) is first and foremost based on the combination of clinical history data and results of skin prick tests (SPT). Other tests, including specific IgE measurement, nasal challenge, and, as a third option, component resolved diagnosis or basophil activation test, may be useful when the diagnosis is difficult because of polysensitization or when negative results of SPT are observed despite a suggestive history for allergy. The atopy patch test (APT) that assesses the type 4 delayed hypersensitivity allergy is currently not sufficiently used. The data obtained in recent studies on the diagnostic utility of the APT in patients with AR was reviewed.
Data Sources:
Review of the literature.
Conclusion:
The data from available studies show that the APT is frequently positive in patients with AR, especially when there is a positive history for atopic dermatitis. Very often, APT is the only positive test and therefore performing only SPT or in vitro IgE measurement may lead to an erroneous diagnosis of nonallergic rhinitis. Recent data suggest a role for APT not only for diagnosis but also in epidemiological investigation on respiratory allergy.

Keywords

Main Subjects

Pediatric rhinology

References

1. Mims JW. Epidemiology of allergic rhinitis. Int Forum Allergy Rhinol. 2014;4(S2):S18–S20.

2. Grabenhenrich LB, Keil T, Reich A, Gough H, Beschorner J, Hoffmann U,et al. Prediction and prevention of allergic rhinitis: A birth cohort study of 20 years. J Allergy Clin Immunol 2015; 136(4): 932-40.e12.

3. Frati F, Dell’Albani I, Passalacqua G, Bonini S, Rossi O, Senna G, et al. A survey of clinical features of allergic rhinitis in adults. Med Sci Monit 2014;20:2151-6.

4. Nathan RA. The burden of allergic rhinitis. Allergy Asthma Proc 2007;28(1):3–9.

5. Reed SD, Lee TA, McCrory DC. The economic burden of allergic rhinitis: a critical evaluation of the literature. Pharmacoeconomics 2004;22(6):345-61.

6. Ryan MW. Asthma and rhinitis: Comorbidities. Otolaryngol Clin North Am 2008;41(2):283-95.

7. Bousquet J, Heinzerling L, Bachert C, Papadopoulos NG, Bousquet PJ, Burney PG, et al. Global Allergy and Asthma European Network; Allergic Rhinitis and its Impact on Asthma. Practical guide to skin prick tests in allergy to aeroallergens. Allergy 2012;67:18-24.

8. Dion GR, Weitzel EK, McMains KC. Current approaches to diagnosis and management of rhinitis. South Med J. 2013;106 (9):526-31.

9. Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, et al. Guideline Otolaryngology Development Group. Clinical practice guideline: allergic rhinitis. Otolaryngol Head Neck Surg. 2015; 152(1 Suppl):S1-43.

10. Luengo O, Cardona V. Component resolved diagnosis: when should it be used? Clin Transl Allergy 2014;4(1):28.

11. Uyttenbroek AP, Sabato V, Faber MA, Cop N, Bridts CH, Lapeere H, et al. Basophil activation tests: time for a reconsideration. Expert Rev Clin Immunol 2014;10(10):1325-35.

12. Ciprandi G, Alesina R, Ariano R, Aurnia P, Borrelli P, Cadario G, et al. Characteristics of patients with allergic polysensitization: the POLISMAIL study. Eur Ann Allergy Clin Immunol 2008; 40(3):77-83.

13. Migueres M, Dávila I, Frati F, Azpeitia A, Jeanpetit Y, Lhéritier-Barrand M, et al. Types of sensitization to aeroallergens: definitions, prevalences and impact on the diagnosis and treatment of allergic respiratory disease. Clin Transl Allergy. 2014;4:16.

14. Moreno C, Justicia JL, Quiralte J, Moreno-Ancillo A, Iglesias-Cadarso A, Torrecillas M, et al. Olive, grass or both? Molecular diagnosis for the allergen immunotherapy selection in polysensitized pollinic patients. Allergy 2004;69(10):1357-63.

15. Canonica GW, Ansotegui IJ, Pawankar R, Schmid-Grendelmeier P, van Hage M, Baena-Cagnani CE, et al. Wao-Aria-Ga2len Task Force. A Wao- Aria- Ga2len consensus document on molecular-based allergy diagnostics. World Allergy Organ J 2013;6:17.

16. Incorvaia C, Mauro M, Ridolo E, Makrì E, Montagni M, Ciprandi G. A pitfall to avoid when using an allergen microarray: the incidental detection of IgE to unexpected allergens. J Allergy Clin Immunol Pract. 2015;3(6):879-82.

17. Rondón C, Campo P, Galindo L, Blanca-López N, Cassinello MS, Rodriguez-Bada JL, et al. Prevalence and clinical relevance of local allergic rhinitis. Allergy. 2012;67(10):1282-8

18. Rondón C, Doña I, López S, Campo P, Romero JJ, Torres MJ, et al. Seasonal idiopathic rhinitis with local inflammatory response and specific IgE in absence of systemic response. Allergy 2008; 63(10):1352-8.

19. Marcucci F, Sensi L. A new method for IgE detection in nasal mucosa. Clin Exp Allergy 1989;19(2):157-62.

20. Fuiano N, Fusilli S, Passalacqua G, Incorvaia C. Allergen-specific immunoglobulin E in the skin and nasal mucosa of symptomatic and asymptomatic children sensitized to aeroallergens. J Investig Allergol Clin Immunol 2010; 20(5):
425-30.

21. Incorvaia C, Fuiano N, Canonica GW. Seeking allergy when it hides: which are the best fitting tests? World Allergy Organ J 2013;6(1):11.

22. Ring J, Kunz B, Bieber T, Przybilla B. The “atopy patch test” with aeroallergens in atopic eczema. J Allergy Clin Immunol 1989;82:195.

23. Sager N, Feldmann A, Schilling C, Kreitsch P, Neumann C. House dust mite specific T cells in the skin of subjects with atopic dermatitis: frequency and lymphokine profile in the allergen patch test. J Allergy Clin Immunol 1992; 89(4):801-10.

24. Wistokat-Wülfing A, Schmidt P, Darsow U, Ring J, Kapp A, Werfel T. Atopy patch test reactions are associated with T lymphocyte-mediated allergen-specific immune responses in atopic dermatitis. Clin Exp Allergy 1999;29(4):
513-21.

25. Kerschenlohr K, Decard S, Przybilla B, Wollenberg A. Atopy patch test reactions show a rapid influx of inflammatory dendritic epidermal cells(IDEC) in patients with extrinsic atopic dermatitis and patients withintrinsic atopic dermatitis patients. J Allergy Clin Immunol 2003; 111(4):869-74.

26. Kerschenlohr K, Decard S, Darsow U, Ollert M, Wollenberg A. Clinical and immunologic reactivity to aeroallergens in “intrinsic” atopic dermatitis patients. J Allergy Clin Immunol 2003; 111:195-97.

27. Darsow U, Laifaoui J, Kerschenlohr K, Wollenberg A, Przybilla B, Wüthrich B, et al. The prevalence of positive reactions in the atopy patch test with aeroallergens and food allergens in subjects with atopic eczema: a European multicenter study. Allergy 2004; 59(12):1318-25.

28. Guler N, Kirerleri E, Tamay Z, Ones U. Atopy patch testing in children with asthma and rhinitis symptoms allergic to house dust mite. Pediatr Allergy Immunol 2006; 17(5): 346-50.

29. Fuiano N, Incorvaia C, Prodam F, Procaccini DA, Bona G. Relationship between the atopy patch test and clinical expression of the disease in children with atopic eczema/dermatitis syndrome and respiratory symptoms. Ann Allergy Asthma Immunol 2008; 101(2):174-8.

30. Sprecher E, Leung DY. Atopic dermatitis: scratching through the complexity of barrier dysfunction. J Allergy Clin Immunol. 2013; 132: 1130-1.

31. Fuiano N, Fusilli S, Incorvaia C. House dust mite-related allergic diseases: role of skin
prick test, atopy patch test, and RAST in the diagnosis of different manifestations of allergy. Eur J Pediatr 2010;169(7):819-24.

32. Fuiano N, Incorvaia C. The atopy patch test: is it time to redefine its significance? Ann Allergy Asthma Immunol 2011;106(4):278-82.

33. Fuiano N, Diddi G, Delvecchio M, Incorvaia C. Diagnostic performance of the atopy patch test with inhalant allergens. J Investig Allergol Clin Immunol 2015; 25(1):34-9

34. Zhao J, Li LF. Atopy patch test to Dermatophagoides mix in a self-selected population in Beijing. Dermatitis 2013;24(2): 82-4.

35. Fuiano N, Diddi G, Delvecchio M, Incorvaia C. Prevalence of positive atopy patch test in an unselected pediatric population. Clin Mol Allergy2013; 24(2):82-4.