Low efficacy of atopy patch test in predicting tolerance development in non-IgE-mediated cow's milk allergy

Allergol Immunopathol (Madr). May-Jun 2018;46(3):241-246. doi: 10.1016/j.aller.2017.07.001. Epub 2017 Oct 12.


Background: The food atopy patch (APT) test has been used in previous studies to help the diagnosis of non-IgE mediated food allergies (FA). The aim of this study was to evaluate the efficacy of different cow's milk APT preparations to predict oral tolerance in children with previous non-IgE-mediated cow's milk allergy (CMA) diagnosis.

Methods: Thirty-two patients non-IgE-mediated CMA diagnosed by oral food challenge (OFC) were enrolled to perform APT with three different cow's milk preparations (fresh, 2% in saline solution, 2% in petrolatum) and comparing with a new OFC after at least three months of diet exclusion.

Results: Only six (18.7%) subjects presented positive OFC to cow's milk. No differences in gender, onset symptoms age, OFC age, Z-score, and exclusion period were found between positive and negative OFC patients. Preparations using fresh milk and powdered milk in petrolatum presented sensitivity equal to zero and specificity 92.3% and 96.1%. The preparation using powdered milk in saline solution showed sensitivity and specificity of 33.3% and 96.1%. Two patients presented typical IgE symptoms after OFC.

Conclusion: Cow's milk APT presented a low efficacy to predict tolerance in patients with previous non-IgE-mediated CMA and should not be used in clinical routine. The presence of typical IgE reactions after OFC hallmark the necessity of previous IgE-mediated investigation for this patient group.

Keywords: Atopy patch test; Cow's milk allergy; Non-IgE-mediated food allergy.

Publication types

  • Clinical Trial

MeSH terms

  • Allergens / administration & dosage
  • Allergens / immunology
  • Animals
  • Cattle
  • Child, Preschool
  • Female
  • Humans
  • Immune Tolerance / immunology
  • Infant
  • Male
  • Milk Hypersensitivity / diagnosis*
  • Milk Proteins / administration & dosage
  • Milk Proteins / immunology
  • Patch Tests / methods*
  • Sensitivity and Specificity


  • Allergens
  • Milk Proteins