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Definitive diagnosis of nut allergy
1Department of Paediatrics, Children's Hospital, Birmingham, UK.
Objective:
To compare findings of tests for nut allergy in children.
Design:
Retrospective survey of a clinical practice protocol.
Setting:
Children's hospital paediatric outpatient clinic.
Subjects:
96 children referred by general practitioners and accident and emergency doctors over 27 months (1994-96).
Main Outcome Measures:
Allergic manifestations (generalised urticarial rash, facial swelling, bronchospasm, anaphylactic shock, vomiting on three occasions) related to specific nut IgE concentrations and following touch, skin prick, or oral ingestion of nuts.
Results:
16 children from a sample of 51 who were tested for nut allergy had no reaction to an oral challenge. Positive IgE against peanuts was found in nine of these 16 children.
Conclusions:
Skin prick testing and IgE measured by radioallergosorbent testing are inadequate tests for nut allergy. The definitive diagnostic test for nut allergy in the hospital setting is direct oral challenge.