Diagnostic accuracy of a skin prick test compared to a DBPCFC for detection of wheat allergy

StudyPopulation testedPrevalenceDiagnostic accuracy for wheatComments
Positive test on challengeImmediate reactionDelayed reactionCombined immediate & delayedSensitivity (%)Specificity (%)PPV (%)NPV (%)
Majamaa 1999162

EL=DS II
39 children aged under 2 years who were suspected of having wheat allergy; 36 had atopic eczema56% overall (67% of the DB challenges, and 40% of the open challenges)

0 for placebo challenge
23%
(of the positive DB challenges)
77%
(of the positive DB challenges, of which 6/17 were atopic eczema, and 10/17 both atopic eczema and gastrointestinal symptoms, 1/17 had diarrhoea)
NR23 (95% CI 9, 46)*100 (95% CI 80, 99)*100 (95% CI 48, 98)*50 (95% CI 33, 68)*See atopy patch test table for more study details.

Commercially available cow’s milk, egg, fish, soya, pea allergens, 200mg of cereal flours, and soya flour diluted in saline for prick testing. Histamine was the positive control. Reactions read at 15 minutes. The test was positive if the mean diameter of the wheal was at least 3mm and the negative control (not specified) was 0 at the same time.

*Results were presented for all children, that is data for both open and DB challenges were only reported as combined data.
Roehr 2001165

EL=DS III
98 children aged 2 months to 11.2 years with atopic eczema (62% mild, 28% moderate, and 10% severe). Not stated whether they were suspected of having food allergy.55%
(64% milk, 67% egg, 51% wheat, 16% soya)

(placebo challenge results NR)
49%26%
All atopic eczema
25%
All atopic eczema plus respiratory or gastrointes tinal symptoms
67536060Results shown are for any reaction (immediate or delayed)
Sampson 1997167

EL=DS III

Related (earlier) publication (including 40 of the children, Sampson 1984168)
196 children and adolescents, aged 0.6–17.9 years with atopic eczema, ‘approximately’ 50% of whom also had asthma and allergic rhinitis.

It is not clear whether all were suspected of having food allergy, but some were based on the comments made regarding use of DB and open food challenges.
46%
(50% to milk, 73% egg, 49% peanut, 28% soya, 22% wheat, 55% fish)
100%*NRNR90513594
Mehl 2006181

EL=DS III
437 consecutive referrals for suspected food allergy. Children aged 3 months – 14 years (median=13 months). 90% had AE36% (n=159)
(DB and open challenge
NRNRNR75644985

NR=not reported

From: Evidence tables

Cover of Atopic Eczema in Children
Atopic Eczema in Children: Management of Atopic Eczema in Children from Birth up to the Age of 12 Years.
NICE Clinical Guidelines, No. 57.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2007 Dec.
Copyright © 2007, National Collaborating Centre for Women’s and Children’s Health.

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