Anaphylaxis during skin testing with food allergens in children

Abstract

Skin testing is the diagnostic cornerstone for allergies and is considered extremely safe. It is usually performed with the prick and the prick-to-prick method. The aim of this study is to report the first two pediatric cases of systemic allergic reactions during skin prick tests (SPT) with commercial food allergens. Both patients had a history of fish allergy. A 5-year-old girl, with a history of atopic dermatitis and asthma, reported an episode of urticaria and angioedema due to ingestion of fish, which had occurred 2 years before consultation. Ten minutes after having completed SPT to fish extracts, which had resulted positive, she suffered from generalized pruritus, nausea, stomach pain, and loss of consciousness. A 9-year-old boy, with a history of asthma and two episodes of acute urticaria and angioedema upon eating fish during infancy, reported a recent episode of oropharyngeal pruritus after tasting salmon. He was evaluated for fish allergy with SPT but developed conjunctivitis and acute urticaria during the first 10 min of the test. Anaphylaxis appears to be a rare side effect of skin testing in pediatric patients. Children with a history of asthma and atopic dermatitis are more likely to react.

The clinical utility of basophil activation testing in diagnosis and monitoring of allergic disease

“…First-line tests include sIgE, SPT and, for insect venom and drug allergy, intradermal test. However, in very few patients (30 in 100 000) SPT and intradermal test might induce systemic symptoms if the allergic response was particularly severe (66,67). Measurement of sIgE may not be possible if the allergen is not available as a routine reagent and may be of limited value depending on the performance of the available reagents.…”

A Case of Anaphylaxis to Legumes During Prick to Prick Test

“…Besinlerle prik to prik testler sırasında allerjik reaksiyon oranı 8/100.000 olarak belirtilmektedir (12). Taze besin allerjenlerinin kullanıldığı prik to prik testlerde standart ekstrelerle yapılanlara göre daha fazla sistemik reaksiyon görülmektedir (13). Prik to prik test sırasında anafilaksi; süt, yumurta, buğday, balık, kalamar, kırmızı et, kivi ve kirazla rapor edilmiştir (11)(12)(13).…”

“…Asthma Allergy Immunol 2016;14:37-41 (13). Bu sunumda anlatılan olgunun öyküsünde mercimek ve bezelye ile anafilaksi olması deri testi sırasında anafilaksi gelişimi için risk faktörü olarak düşünülebilir.…”

Der Basophilen-Aktivierungstest – Ersetzt er die orale Provokation?

“…Alternativ kann mittels Durchflusszytometrie der Anteil der aktivierten Der Basophilen-Aktivierungstest bietet, wie der Nachweis spezifischer IgE-Antikörper, im Vergleich zur Expositionstestung insbesondere den Vorteil einer fehlenden Anaphylaxie-Gefahr, welche je nach Allergen erheblich sein kann [10]. Der Prick-Test stellt insgesamt jedoch ein nur sehr geringes Risiko dar [11,12]. Insbesondere bei Kindern aufwendig und mit einem insgesamt höheren Risiko behaftet, sind orale Provokationstests bei begründetem Verdacht auf eine Nahrungsmittelallergie.…”