title: The diagnosis of Brazil nut allergy using history, skin prick tests, serum-specific immunoglobulin E and food challenges.
abstract: BACKGROUND
  Allergy to Brazil nut is a relatively common nut allergy and can be fatal. However, the evidence is lacking regarding the best approach to its diagnosis.
  
  
  OBJECTIVE
  We sought to determine the relative merits of history, skin prick testing, measurement of serum-specific IgE and challenge in the diagnosis of Brazil nut allergy.
  
  
  METHODS
  Fifty-six children and adults with a history of an allergic reaction to Brazil nut or evidence of sensitization were investigated by questionnaire (n=56), skin prick tests (SPTs) (n=53), measurement of serum-specific IgE to Brazil nut (n=54) and double-blind, placebo-controlled labial, and if necessary oral, challenges (n=19).
  
  
  RESULTS
  Brazil nut allergy occurred in highly atopic individuals of any age with a strong family history of atopy. In 24 of 56 (43%), the history of an immediate reaction was sufficient to make a diagnosis with confidence and an oral challenge was considered unsafe. Of the 19 subjects undertaking the 'gold standard' test of a double-blind, placebo-controlled, food challenge, all six subjects with a SPT of at least 6 mm had a positive challenge and all three subjects with a SPT of 0 mm had a negative challenge. In the remaining 10 (53%) subjects, where SPT was between 1 and 5 mm and serum-specific IgE was less than 3.5 kU/L, an oral challenge was performed resulting in three positive and seven negative challenges.
  
  
  CONCLUSIONS
  A combination of history, SPT and serum-specific IgE was adequate in achieving a diagnosis in the majority (77%) patients with suspected Brazil nut allergy. However, a doubtful history with SPT between 1 and 5 mm, or a serum-specific IgE less than 3.5 kU/L may require an oral challenge to help determine the risk of a Brazil nut allergic reaction.
authors.affiliation: The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.
authors.forename: S
authors.initials: S
authors.lastname: Ridout
authors.forename: S
authors.initials: S
authors.lastname: Matthews
authors.forename: C
authors.initials: C
authors.lastname: Gant
authors.forename: R
authors.initials: R
authors.lastname: Twiselton
authors.forename: T
authors.initials: T
authors.lastname: Dean
authors.forename: S H
authors.initials: SH
authors.lastname: Arshad
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D031383:Bertholletia; D002648:Child; D002675:Child, Preschool; D021181:Egg Hypersensitivity / Q000150:complications; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000150:complications; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D016269:Milk Hypersensitivity / Q000150:complications; D021184:Nut Hypersensitivity / Q000097:blood / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012882:Skin Tests
chemical_list: D007073:Immunoglobulin E