Can conjunctival provocation test facilitate the diagnosis of food allergy in children?
BACKGROUND
Food allergy is common in children, occurring in 5-7.5%. The diagnosis may, however, be difficult. Elevated IgE or positive skin prick test to a food allergen is often considered proof of allergy, but may represent sensitisation without clinical manifestations. For a precise diagnosis oral challenge is necessary, but this is often not performed because of risk of serious allergic reactions. The aim of this study was to evaluate whether conjunctival provocation test would facilitate the diagnosis of IgE-mediated food allergy.


METHODS
One hundred and forty-nine children with 174 possible diagnoses of food allergy were included. General examination, skin prick test and specific IgE were performed, as well as conjunctival provocation test of the suspected food allergen. Open food challenges and double-blind placebo controlled tests were performed in order to diagnose possible food allergy.


RESULTS
Forty-six children with strongly positive conjunctival reactions (rubor, itching, oedema) to fifty food allergens were all proven to have allergy to the food in question. The children with negative conjunctival provocation tests showed no allergic reactions when challenged.


CONCLUSIONS
We find that a strongly positive conjunctival reaction to a food allergen correlates well with true allergy. An oral challenge should be carefully performed. With a negative conjunctival test an oral challenge may safely be performed.
Krane Kvenshagen
B
B
Oestfold Hospital Trust, Department of Pediatrics, Fredrikstad, Norway. bent-kv@online.no
Jacobsen
M
M
Halvorsen
R
R
D000293:Adolescent; D000485:Allergens / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003228:Conjunctiva / Q000276:immunology / Q000378:metabolism*; D004527:Egg Proteins / Q000276:immunology; D005260:Female; D029941:Fish Proteins / Q000276:immunology; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000276:immunology* / Q000503:physiopathology; D006801:Humans; D007114:Immunization; D007073:Immunoglobulin E / Q000097:blood; D007159:Immunologic Tests / Q000379:methods; D007223:Infant; D008297:Male; D008894:Milk Proteins / Q000276:immunology; D011237:Predictive Value of Tests; D012882:Skin Tests
D000485:Allergens; D004527:Egg Proteins; D029941:Fish Proteins; D008894:Milk Proteins; D007073:Immunoglobulin E