The British Society for Allergy and Clinical Immunology Standards of Care Committee have developed the first ever guideline for the investigation and management of suspected nut allergy in children and adults. The guidance was developed following an extensive literature review, expert consensus and wide healthcare professional and public consultation.
It includes diagnostic algorithms and a detailed discussion of the use of diagnostic tests to help accurately confirm nut allergy. Clinical diagnosis of primary nut allergy, it states, can be made by the combination of a typical clinical presentation and evidence of nut-specific IgE shown by a positive skin prick test (SPT) or specific IgE (sIgE) test. It adds that while a positive SPT or sIgE response indicates the probable presence of clinical allergy, it is not a measure of clinical severity. SPT ≥8 mm or sIgE ≥15KU/L to peanut is highly predictive of clinical allergy. Cut-off values are not available for tree nuts. Diagnostic food challenges are usually not necessary.
The guidance also discusses management plans as well as detailed advice on counselling patients with nut allergy, early-life prevention, testing of siblings and the role of immunotherapy.
The guidance is published in Clinical & Experimental Allergy .