Q:

10/17/2013
Is there any evidence to support the use of food patch testing for the evaluation and management of atopic dermatitis or various GI complaints (such as nausea, abdominal pain and diarrhea)?

I am familiar with the evidence to support the use of food patch testing for eosinophilic esophagitis but have recently seen a number of patients who had food patch testing placed by another provider for various other reasons. In some cases, elimination diets of these offending foods have seemed to result in clinical improvement but trials of food reintroduction were not performed so unable to confirm whether this was coincidental. Many of these patients are requesting I perform patch testing to see if they still have these food sensitivities (or parents are asking for this patch testing for younger siblings who have not yet had testing) and I am not sure how best to proceed. Many of these patients are children, and thus I would like to minimize food avoidance unless it is truly needed.

A:

Thank you for your inquiry.

As you are well aware, the role of atopic food patch testing is in flux and has been a matter of controversy. To my knowledge, it has been best studied in atopic dermatitis and eosinophilic esophagitis. Its role in the evaluation of other types of reactions to foods has been less well delineated. The topic itself has been reviewed in great detail in a reference which should be readily available to you. This reference is our best guide at this time to the approach to patients with food allergies, and the section under “food patch testing” will give you the best available answers to your questions.

The reference is: Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel. Journal of Allergy and Clinical Immunology 2010; 126(6) Supplement: S1-S58. The lead author is Dr. Joshua Boyce. On page S24 of this document, there begins a discussion which contains references to atopic patch testing. Because of the complexity of the issue and the length of the discussion, I cannot easily summarize the findings for you or copy and paste the entire discussion. However, within a few pages, you will find the best available thoughts regarding the issues presented by your inquiry.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology