Is it necessary to test for all tree nuts when a patient presents with IgE mediated symptoms to an isolated tree nut?
We tend to reflexively test for all tree nuts in this case, but is it reasonable to only test for the isolated tree nut and/or the similar nut, such as cashew/pistachio? Other tree nuts are frequently positive on SPT along with IgE, but published data on sensitivity/specificity of SPT and IgE levels for tree nuts make the interpretation difficult.
2 Answers
Mednet MemberInvited Expert
Allergy & Immunology · University of Maryland School of Medicine
Answered on
Having an allergy to a specific tree nut does not mean a patient will be allergic to others, but there are some that are cross-reactive, and it may be worthwhile testing for the cross-reactive tree nut as opposed to testing for all. For example, if the patient had a reaction to cashew, testing for p...
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Mednet Member
Allergy & Immunology · George R Gottlieb Md Pc
Answered on
I assume every patient allergic to cashew is allergic to pistachio and warn them that they are at risk. Most patients allergic to walnuts will, in my experience, be allergic to cashews, but it may be worth testing. Almond is the least likely to react, and an in-office challenge is often worthwhile, ...
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