Peanut, tree nut, and seed allergy: Diagnosis
- Hugh A Sampson, MD
Hugh A Sampson, MD
- Kurt Hirschhorn Professor of Pediatrics
- Icahn School of Medicine at Mount Sinai
Peanut, tree nut, and seed allergies are some of the most common food allergies in both children and adults. These allergies tend to cause severe reactions and usually persist over time.
The diagnosis of peanut, tree nut, and seed allergies is presented in this topic review. A general discussion of the diagnosis of food allergy is presented elsewhere. (See "History and physical examination in the patient with possible food allergy" and "Diagnostic evaluation of food allergy".)
Clinical features and management of these allergies are discussed separately, as is treatment for food-induced anaphylaxis. General discussions of food allergy are presented separately in appropriate topic reviews. (See "Peanut, tree nut, and seed allergy: Clinical features" and "Peanut, tree nut, and seed allergy: Management" and "Food-induced anaphylaxis".)
DIAGNOSIS OF IgE-MEDIATED REACTIONS
An unequivocal history of an immediate reaction consisting of typical allergic symptoms following the isolated ingestion of a peanut, tree nut, or seed product, supported by positive tests for specific immunoglobulin E (IgE) antibodies, is usually sufficient to establish the diagnosis for suspected IgE-mediated reactions. Either skin prick tests or in vitro tests for IgE are usually performed initially. (See "History and physical examination in the patient with possible food allergy" and "Overview of in vitro allergy tests" and "Diagnostic evaluation of food allergy".)
With the exception of in vitro immunoassays for specific IgE (which are still erroneously referred to as IgE RAST [radioallergosorbent test] tests), other diagnostic allergy procedures, including skin testing and food challenges, should be performed by allergy specialists with training in the management of serious allergic reactions. (See "Overview of skin testing for allergic disease" and "Oral food challenges for diagnosis and management of food allergies".)
- Maloney JM, Rudengren M, Ahlstedt S, et al. The use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy. J Allergy Clin Immunol 2008; 122:145.
- Zavalkoff S, Kagan R, Joseph L, et al. The value of sesame-specific IgE levels in predicting sesame allergy. J Allergy Clin Immunol 2008; 121:1508.
- Sicherer SH, Sampson HA. Peanut allergy: emerging concepts and approaches for an apparent epidemic. J Allergy Clin Immunol 2007; 120:491.
- Sampson HA, Ho DG. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. J Allergy Clin Immunol 1997; 100:444.
- Sampson HA. Utility of food-specific IgE concentrations in predicting symptomatic food allergy. J Allergy Clin Immunol 2001; 107:891.
- Pucar F, Kagan R, Lim H, Clarke AE. Peanut challenge: a retrospective study of 140 patients. Clin Exp Allergy 2001; 31:40.
- Beyer K, personal communication, 2009.
- Vereda A, van Hage M, Ahlstedt S, et al. Peanut allergy: Clinical and immunologic differences among patients from 3 different geographic regions. J Allergy Clin Immunol 2011; 127:603.
- Lieberman JA, Glaumann S, Batelson S, et al. The utility of peanut components in the diagnosis of IgE-mediated peanut allergy among distinct populations. J Allergy Clin Immunol Pract 2013; 1:75.
- Eller E, Bindslev-Jensen C. Clinical value of component-resolved diagnostics in peanut-allergic patients. Allergy 2013; 68:190.
- Lopes de Oliveira LC, Aderhold M, Brill M, et al. The value of specific IgE to peanut and its component Ara h 2 in the diagnosis of peanut allergy. J Allergy Clin Immunol Pract 2013; 1:394.
- Asarnoj A, Nilsson C, Lidholm J, et al. Peanut component Ara h 8 sensitization and tolerance to peanut. J Allergy Clin Immunol 2012; 130:468.
- Sicherer SH, Wood RA. Advances in diagnosing peanut allergy. J Allergy Clin Immunol Pract 2013; 1:1.
- Masthoff LJ, Mattsson L, Zuidmeer-Jongejan L, et al. Sensitization to Cor a 9 and Cor a 14 is highly specific for a hazelnut allergy with objective symptoms in Dutch children and adults. J Allergy Clin Immunol 2013; 132:393.
- Sporik R, Hill DJ, Hosking CS. Specificity of allergen skin testing in predicting positive open food challenges to milk, egg and peanut in children. Clin Exp Allergy 2000; 30:1540.
- Ho MH, Heine RG, Wong W, Hill DJ. Diagnostic accuracy of skin prick testing in children with tree nut allergy. J Allergy Clin Immunol 2006; 117:1506.
- Hill DJ, Heine RG, Hosking CS. The diagnostic value of skin prick testing in children with food allergy. Pediatr Allergy Immunol 2004; 15:435.
- Roberts G, Lack G. Diagnosing peanut allergy with skin prick and specific IgE testing. J Allergy Clin Immunol 2005; 115:1291.
- Astier C, Morisset M, Roitel O, et al. Predictive value of skin prick tests using recombinant allergens for diagnosis of peanut allergy. J Allergy Clin Immunol 2006; 118:250.
- Rancé F, Abbal M, Lauwers-Cancès V. Improved screening for peanut allergy by the combined use of skin prick tests and specific IgE assays. J Allergy Clin Immunol 2002; 109:1027.
- Arbes SJ Jr, Gergen PJ, Elliott L, Zeldin DC. Prevalences of positive skin test responses to 10 common allergens in the US population: results from the third National Health and Nutrition Examination Survey. J Allergy Clin Immunol 2005; 116:377.
- Nicolaou N, Poorafshar M, Murray C, et al. Allergy or tolerance in children sensitized to peanut: prevalence and differentiation using component-resolved diagnostics. J Allergy Clin Immunol 2010; 125:191.
- Asarnoj A, Ostblom E, Ahlstedt S, et al. Reported symptoms to peanut between 4 and 8 years among children sensitized to peanut and birch pollen - results from the BAMSE birth cohort. Allergy 2010; 65:213.
- Niggemann B, Schmitz R, Schlaud M. The high prevalence of peanut sensitization in childhood is due to cross-reactivity to pollen. Allergy 2011; 66:980.
- Gangur V, Kelly C, Navuluri L. Sesame allergy: a growing food allergy of global proportions? Ann Allergy Asthma Immunol 2005; 95:4.
- Du Toit G, Roberts G, Sayre PH, et al. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med 2015; 372:803.
- Togias A, Cooper SF, Acebal ML, et al. Addendum Guidelines for the Prevention of Peanut Allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases-Sponsored Expert Panel. Pediatr Dermatol 2017; 34:e1.