title: The use of serum-specific IgE measurements for the diagnosis of peanut, tree nut, and seed allergy.
abstract: BACKGROUND
  The gold standard for diagnosing food allergy is the double-blind, placebo-controlled food challenge. Diagnostic food-specific IgE levels might assist in diagnosing food allergies and circumventing the need for food challenges.
  
  
  OBJECTIVE
  The purpose of this study was to determine the utility of food-specific IgE measurements for identifying symptomatic peanut, tree nut, and seed allergies and to augment what is known about the relationships among these foods.
  
  
  METHODS
  Patients referred for suspected peanut or tree nut allergies answered a questionnaire about their perceived food allergies. Allergen-specific diagnoses were based on questionnaire, medical history, and, when relevant, skin prick tests and serum specific IgE levels. Sera from the patients were analyzed for specific IgE antibodies to peanuts, tree nuts, and seeds by using ImmunoCAP Specific IgE (Phadia, Inc, Uppsala, Sweden).
  
  
  RESULTS
  Three hundred twenty-four patients (61% male; median age, 6.1 years; range, 0.2-40.2 years) were evaluated. The patients were highly atopic (57% with atopic dermatitis and 58% with asthma). The majority of patients with peanut allergy were sensitized to tree nuts (86%), and 34% had documented clinical allergy. The relationship between diagnosis and allergen-specific IgE levels were estimated by using logistic regression. Diagnostic decision points are suggested for peanut and walnut. Probability curves were drawn for peanut, sesame, and several tree nuts. High correlations were found between cashew and pistachio and between pecan and walnut.
  
  
  CONCLUSIONS
  Quantification of food-specific IgE is a valuable tool that will aid in the diagnosis of symptomatic food allergy and might decrease the need for double-blind, placebo-controlled food challenges.
authors.affiliation: Mount Sinai School of Medicine, New York, NY, USA. jennifer.maloney@mssm.edu
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Maloney
authors.forename: Magnus
authors.initials: M
authors.lastname: Rudengren
authors.forename: Staffan
authors.initials: S
authors.lastname: Ahlstedt
authors.forename: S A
authors.initials: SA
authors.lastname: Bock
authors.forename: Hugh A
authors.initials: HA
authors.lastname: Sampson
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D005512:Food Hypersensitivity / Q000175:diagnosis* / Q000276:immunology; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood*; D007223:Infant; D008297:Male; D009754:Nuts / Q000276:immunology*; D021183:Peanut Hypersensitivity / Q000175:diagnosis*; D012639:Seeds / Q000276:immunology*; D011795:Surveys and Questionnaires
chemical_list: D000485:Allergens; D007073:Immunoglobulin E