Accidental Skin Contact With Food Allergens Does Not Trigger Anaphylaxis in Children: A Prospective Multicentre Study

ABSTRACT Aim Children with food allergies (FA) and their parents frequently fear that accidental skin contact with allergenic foods may cause severe systemic reactions. This study aimed to evaluate the risk of systemic allergic reactions following controlled skin exposure to common food allergens in children with confirmed FA. Methods In this multicentre study, children aged 1–18 years with FA underwent patch testing with allergenic food applied to the forearm for 15 min. Two age‐ and sex‐matched control groups were included (with atopic comorbidities without FA and healthy controls). Clinical reactions were monitored. Results 293 children enrolled, including 192 (65.5%) with FA. Among 263 patch tests in the FA group, 220 (83.7%) were negative, 40 (15.2%) resulted in mild local skin reactions, and 3 (1.1%) induced more extensive skin reactions limited to the tested arm. No systemic reactions or anaphylaxis occurred. Cow's milk was associated with a higher rate of skin reactions: 16/68 (23.5%) mild local and 2/68 (2.9%) more extensive reactions. Younger age was the main predictor of skin reactivity. Conclusions In this cohort, skin contact with allergenic foods in children with FA did not induce anaphylaxis and rarely results in mild local symptoms. These findings support that incidental skin exposure poses minimal risk and may help reduce unnecessary environmental restrictions and their associated psychosocial burden.