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The diagnosis of Brazil nut allergy using history, skin prick tests, serum-specific immunoglobulin E and food challenges.
Clin Exp Allergy 2006; 36(2):226-32CE

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.

CONCLUSION

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+Show Affiliations

The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16433861

Citation

Ridout, S, et al. "The Diagnosis of Brazil Nut Allergy Using History, Skin Prick Tests, Serum-specific Immunoglobulin E and Food Challenges." Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, vol. 36, no. 2, 2006, pp. 226-32.
Ridout S, Matthews S, Gant C, et al. The diagnosis of Brazil nut allergy using history, skin prick tests, serum-specific immunoglobulin E and food challenges. Clin Exp Allergy. 2006;36(2):226-32.
Ridout, S., Matthews, S., Gant, C., Twiselton, R., Dean, T., & Arshad, S. H. (2006). The diagnosis of Brazil nut allergy using history, skin prick tests, serum-specific immunoglobulin E and food challenges. Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology, 36(2), pp. 226-32.
Ridout S, et al. The Diagnosis of Brazil Nut Allergy Using History, Skin Prick Tests, Serum-specific Immunoglobulin E and Food Challenges. Clin Exp Allergy. 2006;36(2):226-32. PubMed PMID: 16433861.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The diagnosis of Brazil nut allergy using history, skin prick tests, serum-specific immunoglobulin E and food challenges. AU - Ridout,S, AU - Matthews,S, AU - Gant,C, AU - Twiselton,R, AU - Dean,T, AU - Arshad,S H, PY - 2006/1/26/pubmed PY - 2006/8/22/medline PY - 2006/1/26/entrez SP - 226 EP - 32 JF - Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology JO - Clin. Exp. Allergy VL - 36 IS - 2 N2 - 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. CONCLUSION: 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. SN - 0954-7894 UR - https://www.unboundmedicine.com/medline/citation/16433861/The_diagnosis_of_Brazil_nut_allergy_using_history_skin_prick_tests_serum_specific_immunoglobulin_E_and_food_challenges_ L2 - https://doi.org/10.1111/j.1365-2222.2006.02426.x DB - PRIME DP - Unbound Medicine ER -