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Skin test reactivity in infancy.

J L Ménardo, J Bousquet, M Rodière

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    Pediatric allergy diagnosis using skin prick tests is feasible in infants. While infants show reduced reactivity to controls, smaller allergen-induced wheal sizes are normal, allowing accurate interpretation.

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    Area of Science:

    • Pediatric Allergy and Immunology
    • Dermatology
    • Clinical Diagnostics

    Background:

    • Skin prick testing is a cornerstone for diagnosing reaginic (allergic) conditions.
    • Interpreting skin tests in young children, particularly those under three years old, presents unique challenges.
    • Infantile skin reactivity patterns may differ from adults, impacting diagnostic accuracy.

    Purpose of the Study:

    • To evaluate the feasibility and interpretation of skin prick tests in infants aged 0-24 months.
    • To compare skin test responses in infants with those in non-allergic adult subjects.
    • To establish reference parameters for histamine and allergen-induced wheal sizes in infancy.

    Main Methods:

    • Seventy-eight infants (birth to 24 months) underwent prick testing.
    • Tests included histamine hydrochloride (1 & 10 mg/ml), codeine phosphate (50 mg/ml), and allergenic extracts.
    • Responses were compared to 30 non-allergic adult controls; serum specific IgE confirmed allergies.

    Main Results:

    • A significant hyporeactivity (p<0.001) to histamine and codeine phosphate was observed in infants, especially under 6 months.
    • Six allergic infants showed positive prick tests to food/inhalant allergens, confirmed by IgE and clinical history.
    • Allergen-induced wheal sizes in infants ranged from 2-5 mm, indicating smaller reactions are typical.

    Conclusions:

    • Skin prick tests can be reliably performed and interpreted in infants.
    • Understanding the reduced reactivity to positive controls and smaller allergen-induced wheal sizes is crucial for accurate diagnosis in this age group.
    • These findings support the utility of skin prick testing for diagnosing allergies in infants.