Elsevier

The Journal of Pediatrics

Volume 166, Issue 2, February 2015, Pages 401-406.e1
The Journal of Pediatrics

Original Article
Allergen Skin Prick Testing in Early Childhood: Reproducibility and Prediction of Allergic Symptoms into Early Adulthood

https://doi.org/10.1016/j.jpeds.2014.10.009Get rights and content

Objective

To assess the predictive value of skin prick testing in early childhood on subsequent allergic symptoms up to adult age.

Study design

A cohort of 200 unselected healthy newborns was prospectively followed from birth to 20 years of age. Of them, 163 (82%) were reassessed at age 5 years, 150 (76%) at age 11 years, and 164 (83%) at age 20 years with a skin prick test that included 11 common allergens. On the basis of clinical examination and structured interview, the occurrence of atopic dermatitis, allergic rhinoconjunctivitis, recurrent wheezing, and symptoms of food hypersensitivity were recorded at each of the follow-up visits.

Results

The reproducibility of skin prick test positivity at age 5 years was 100% at ages 11 and 20 years, ie, none of the skin prick–positive subjects turned negative during the follow-up. Gaining of new sensitizations to aeroallergens was common. Skin prick test positivity at age 5 years predicted allergic symptoms at ages 11 (sensitivity 28%, specificity 94%) and 20 years (sensitivity 23%, specificity 91%) but not atopic dermatitis.

Conclusions

Skin prick test positivity at age 5 years strongly predicts later skin prick test positivity and is associated with respiratory symptoms, ie, allergic rhinoconjunctivitis and recurrent wheezing, at ages 11 and 20 years. However, skin prick test negativity at age 5 years does not exclude sensitization and allergic symptoms at a later age.

Section snippets

Methods

SPT was performed at ages 5, 11, and 20 years with standardized allergen extracts (ALK, Copenhagen, Denmark) of birch, alder, timothy, Kentucky blue, mugwort, cat, dog, Dermatophagoides pteronyssinus, cow's milk, egg, and codfish on healthy skin on the forearm. Histamine hydrochloride (10 mg/mL) and a diluent control were included. A positive SPT was defined as a test reaction with a mean diameter ≥3 mm and equal to or greater than one-half of the diameter of the histamine wheal.14

Atopic

Reproducibility of SPT Results from Age 5 Years to Ages 11 and 20 Years

The reproducibility of SPT was assessed by comparing the SPT results at age 5 years to those at ages 11 and 20 years, and the SPT results at age 11 years to those at age 20 years. Of the 163 children seen at age 5 years, 128 (79%) were seen at age 11 years, and 138 (85%) at age 20 years (Table II; available at www.jpeds.com). All the subjects with at least one positive SPT at age 5 years were SPT positive also at ages 11 and 20 years, ie, none of the subjects lost their SPT positivity during

Discussion

SPT is a well-established method for assessing immunoglobulin E–mediated sensitization and widely used in diagnosing allergic conditions; however, the long-term reproducibility and predictive value are limited. We assessed the predictive value of SPT in children, ie, at age 5 years, on subsequent allergic symptoms up to adult age.

In the present follow-up cohort of healthy children, the reproducibility of SPT positivity detected at age 5 years was 100% at ages 11 and 20 years. Thus, none of the

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  • Cited by (0)

    Supported by the Foundation for Pediatric Research, the Finnish Medical Foundation, the National Graduate School of Clinical Investigation, and the Helsinki University Hospital Research Funds. The authors declare no conflicts of interest.

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