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Peanut, tree nut, and seed allergy: Diagnosis

Julie Wang, MD
Section Editor
Scott H Sicherer, MD, FAAAAI
Deputy Editor
Elizabeth TePas, MD, MS


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".)


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".)

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Literature review current through: Nov 2017. | This topic last updated: Apr 24, 2017.
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