Peanut Allergy Diagnosis
Recommendations
Certain tests may be more appropriate than others in particular situations. We suggest that the choice of SPT, sIgE, or Ara h 2 sIgE is not critical in circumstances where there is high pre-test probability of peanut allergy.
While testing of patients with low pre-test probability is not generally recommended, if the decision is made to test in these circumstances, from a test precision standpoint, use of Ara h 2 rather than SPT or sIgE can help decrease misclassification of patients as peanut allergic, leading to less harm through falsely positive diagnosis. When testing individuals with low pre-test probability, it is recommended that an oral food challenge still be performed to validate the clinical significance of the detection of sensitization, given that the low pre-test probability in the setting of detectable sensitization translates to only moderate post-test odds of a diagnosis.
Recommendation Grading
Overview
Title
Peanut Allergy Diagnosis
Authoring Organizations
American College of Allergy, Asthma, and Immunology
American Academy of Allergy, Asthma & Immunology
Publication Month/Year
July 17, 2020
Last Updated Month/Year
February 6, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Older adult
Health Care Settings
Ambulatory, Childcare center, School
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Diagnosis
Diseases/Conditions (MeSH)
D021183 - Peanut Hypersensitivity, D000074924 - Nut and Peanut Hypersensitivity, D000486 - Allergy and Immunology
Keywords
peanut allergy, nut allergy, serologic IgE testing, allergy testing, allergic reaction
Source Citation
Greenhawt M, Shaker M, Wang J, Oppenheimer JJ, Sicherer S, Keet C, Swaggart K, Rank M, Portnoy JM, Bernstein J, Chu DK, Dinakar C, Golden D, Horner C, Lang DM, Lang ES, Khan DA, Lieberman J, Stukus D, Wallace D, Peanut Allergy Diagnosis- a 2020 Practice Parameter Update, Systematic Review, and GRADE Analysis, Journal of Allergy and Clinical Immunology (2020), doi: https://doi.org/10.1016/j.jaci.2020.07.031