Skin Application of Food Prior to Food Challenges

There is one situation where direct application of food to the skin may be of practical value, and that is prior to a food challenge in a child in whom one fears an anaphylactic reaction. An example might be a 6-month-old infant with a history of a severe allergic reaction to egg. If the parents wish to see if the child has outgrown the allergy without directly administering egg and risking a violent reaction, a simple approach is to rub some raw egg white into the skin and observe the skin for a few minutes. If the skin application of egg in this way causes an urticarial reaction, then a gradual diminution and disappearance of this response during the succeeding months and years can probably be taken to indicate the development of tolerance, and a continuing brisk response to skin contact would constitute a deterrent to an oral challenge. However, this is only an approximate guide, and there are a number of possible reasons why such testing may give false-positive (e.g., using a raw food when the food is usually eaten cooked, such as egg or potato) or false-negative (e.g., the child is receiving antihista-mine drug) results.

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