Food‐induced contact urticaria syndrome (CUS) in young children with atopic dermatitis: practical consequences

Abstract

Eight children, aged less than 5 years, with atopic dermatitis (AD) and food-induced contact urticaria are described. These cases illustrate the clinical importance of food-induced contact urticaria. The symptoms can be easily provoked and imitated in children under 4 years of age using the 'Skin Application Food Test' (SAFT). This test includes the application of foods on the skin, in the form they are consumed. The clinician should pay attention to clinical symptoms of immediate-contact reactions, easy to recognize. The common skin symptoms are swollen face, in particular the hps, and itching or pain in the mouth and (contact) urticaria. Another dominating symptom is evident refusal of foods. Non-immunological irritation reactions are also common in these children. Confusion with irritation reactions is first avoided of all by strict selective interpretation of the history told by the mother; and second, both the SAFT and the CAP RAST are positive only in immune-mediated processes.

Immediate‐ and Delayed‐Type Contact Hypersensitivity in Children Older than 5 Years With Atopic Dermatitis: A Pilot Study Comparing Different Tests

“…Contact urticaria syndrome is an important skin condition in infants and toddlers with AD and food allergy, with the skin as target organ (6,7). Based on its mechanism, several tests such as Salo's open ap-plication test, Gronemeyer's Reibtest, and Oranje's SAFT have been developed (21,22).…”

“…vating role in AD, especially in itifants and toddlers (2)(3)(4)(5)(6)(7). Contact urticaria syndrome (CUS) especially h^ been recognized in the last 15 years.…”

Frequency and significance of immediate contact reactions to peanut in peanut‐sensitive children

“…All parents of children undergoing I‐SAFT gave verbal consent for the procedure. The I‐SAFT method used was a modification of an SAFT method described previously [15]. One gram of peanut butter (Dick Smith's smooth peanut butter) on a 2.5 cm cardboard square was applied under an occlusive dressing directly to an area of skin free of other lesions or eczema, usually the upper arm.…”

“…However, the clinical usefulness of the APT seems to be limited to delayed hypersensitivity reactions. In terms of predicting immediate hypersensitivity reactions, Oranje et al [15] described a method of applying food directly to the skin, the skin application food test (SAFT), as a diagnostic test for food allergy. The labial food challenge test has also been suggested for the diagnosis of food allergy in children [16].…”