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The atopy patch test: is it time to redefine its significance?
Nicola Fuiano1, Cristoforo Incorvaia
1Paediatric Allergy Service, ASL Fg, San Severo, Italy. fuiano50@tin.it
Summary
The atopy patch test (APT) is valuable for diagnosing atopic eczema/dermatitis syndrome (AEDS) and related respiratory conditions like rhinitis and asthma. It may be more significant than other tests in patients with a history of AEDS.
Area of Science:
- Allergy and Immunology
- Dermatology
- Respiratory Medicine
Background:
- The atopy patch test (APT) is recognized for diagnosing atopic eczema/dermatitis syndrome (AEDS).
- Emerging evidence suggests APT positivity in patients with rhinitis or asthma, prompting investigation into underlying mechanisms.
- Understanding these mechanisms is crucial for comprehensive diagnosis and management of allergic conditions.
Purpose of the Study:
- To investigate the mechanisms behind positive atopy patch tests (APT) in patients with atopic eczema/dermatitis syndrome (AEDS), rhinitis, or asthma.
- To compare the diagnostic significance of APT with skin prick tests (SPT) and in vitro IgE tests in allergic individuals.
- To explore the role of sensitization mechanisms in different clinical manifestations of allergy.
Main Methods:
- A comprehensive literature search of MEDLINE databases from 1989 to the present was conducted.
- Articles focusing on APT results in patients with AEDS, rhinitis, or asthma due to inhalant allergen sensitization were analyzed.
- The pathophysiology of AEDS and sensitization pathways were examined.
Main Results:
- The atopy patch test (APT) for dust mites is frequently positive, sometimes exclusively, in individuals with AEDS and/or respiratory symptoms (rhinitis, asthma).
- Positive skin prick tests (SPT) and in vitro IgE tests are more common in patients without a history of AEDS.
- APT appears particularly relevant in diagnosing AEDS, especially when linked to dust mite allergy.
Conclusions:
- The atopy patch test (APT) holds greater diagnostic significance than SPT or IgE tests for patients with a current or past history of atopic eczema/dermatitis syndrome (AEDS).
- Distinct sensitization mechanisms likely underlie different clinical expressions of allergy, such as AEDS versus isolated respiratory symptoms.
- Filaggrin-dependent skin barrier dysfunction may facilitate mite allergen entry, leading to sensitization revealed by a positive APT.
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