BACKGROUND: Atopic Dermatitis is a chronic inflammatory skin disease. Food allergens are important in the pathogenesis in 1/3 of the cases. Several mechanisms are involved in the pathogenesis of Atopic Dermatitis. Immediate reactions are identified by both measurement of specific IgE and skin prick test. Atopy Patch Test seems to be relevant in the investigation of patients with suspected delayed-type reactions. OBJECTIVES: To evaluate the standardization of this method concerning allergen concentration, occlusion time and interpretation, and determine the specificity and sensitivity of the Atopy Patch Test according to the skin prick test and specific IgE levels in food allergy diagnosis in children with Atopic Dermatitis. METHODS: Seventy-two children, aged 2-12 years were selected and followed at the allergy clinic of the Hospital São Zacharias. Skin prick test, specific IgE and food Atopy Patch Test (cow's milk, egg, soy and wheat) were carried out. Three groups were submitted to the Atopy Patch Test: (1) Atopic Dermatitis with or without Rhinitis and Asthma; (2) Rhinitis and or Asthma without AD; (3) Healthy individuals. RESULTS: In group 1, 40% of the patients presented positive reactions. The longer the exposure time (48h and 72h), the higher the sensitivity. In group 2, the test was more specific than sensitive for all the extracts, with increased sensitivity the longer the time of exposure (72h). In group 3, 8.3% presented positive tests. CONCLUSION: APT evidenced a great diagnostic value in late-phase reactions to food, with high specificity. It showed to be a specific and reliable tool in comparison with the healthy group's results.
Resumo: A Urticária de Pressão Tardia é considerada uma doença rara, cujo quadro clínico é diferente da urticária clássica e pode envolver manifestações sistêmicas. Sendo assim, o diagnóstico é pouco frequente, até mesmo pelos especialistas. Neste artigo, apresentamos uma paciente, com história típica de lesões desencadeadas por pressão e que, por apresentar febre e leucocitose, foi internada para investigação de quadro infeccioso. Palavras-chave: Classificação; Diagnóstico diferencial; Urticária Abstract: Delayed Pressure Urticaria is considered a rare disease, with clinical diagnosis different from classical urticaria, with possible systemic manifestations. Therefore, it is frequently underdiagnosed, even by specialists. In this article, the case of a patient with a typical history of pressure-induced lesions is presented. Because the patient had fever and leukocytosis, she was admitted to a hospital for investigation of infection. Keywords: Classification; Diagnosis, differential; Urticaria 2 Clinicamente, a UPT se caracteriza pelo aparecimento de edema profundo, doloroso e eritematoso, ocorrendo de 30 minutos a 9 horas, após ter sido exercida uma pressão mecânica estática sobre a pele, 1,3,4 e com duração de 12 (doze) a 72 (setenta e duas)horas. 2Os sintomas perduram em média três anos, mas o curso natural da doença é variável, podendo persistir por vários anos, com períodos de remissão e de exacerbações. 2,[4][5][6] Na sua forma isolada, constituem menos de 2% de todas as urticárias. Dentre os pacientes com urticá-ria crônica idiopática, 37% têm UPT, enquanto mais de 90% dos pacientes com UPT têm urticária crônica idiopática ou angioedema associados. 4,6,7 É possível que esta doença não seja tão rara, mas pouco conhecida e subdiagnosticada, ou mesmo confundida com outras doenças, de caráter sistêmico. 6A UPT representa um dos tipos de urticária de mais difícil controle. A principal abordagem terapêuti-ca é a orientação para que o paciente evite situações que precipitem as lesões.4 O tratamento medicamentoso é, em geral, insatisfatório e inclui: anti-histamíni-cos, anti-inflamatórios não-esteroidais (AINES), corticosteroides tópicos ou sistêmicos, sulfasalazina e dapsona.5 O uso de anti-histamínicos H1 tem pouco efei-
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