The diagnostic value of APT for food allergy in children: a systematic review and meta‐analysis

Background The role of atopy patch test (APT) in the diagnosis of food allergy (FA) remains largely controversial. In our meta‐analysis, we aimed to evaluate the accuracy of APT for diagnosing FA in children. Methods Pubmed, Embase and Cochrane Library were searched for studies regarding the diagnostic value of APT for FA in children compared to oral food challenge (double‐blind placebo‐controlled food challenge and/or open food challenge). The last search was conducted on November 11, 2017. Two reviewers independently screened relevant studies and assessed the quality by QUADAS‐2. Meta‐analysis was performed to calculate the pooled sensitivity, specificity, DOR (diagnostic odds ratio), PLR (positive likelihood ratio), NLR (negative likelihood ratio) with their 95% confidence intervals (CIs). Subgroup analyses were conducted according to different food allergens, atopic dermatitis, gastrointestinal symptoms, and age younger than 3 years. Results Forty‐one studies were included in the meta‐analysis. The pooled sensitivity, specificity, PLR, NLR and DOR were 50.30% (95% CI 48.40%‐52.30%), 86.60% (95% CI 85.30%‐87.80%), 3.405 (95% CI 2.594‐4.470), 0.545 (95% CI 0.469‐0.634) and 7.528 (95% CI 5.507‐11.206), respectively. However, for children with FA‐related gastrointestinal symptoms, the pooled sensitivity and specificity were 57.40% (95% CI 52.10%‐62.50%) and 91.50% (95% CI 88.30%‐94.10%) respectively. Conclusions Our findings suggest that APT is specific but not sensitive for diagnosing FA in children, especially in children with FA‐related gastrointestinal symptoms.