How can a tree nut allergy be diagnosed?

You should talk to your doctor about your signs and symptoms. Keep a log of when they come on, and what you eat a few hours before they appear. You or your doctor might see a pattern emerging and might be able to narrow down the list of foods to which you may be allergic. There are a few tests that can be done to confirm or aid a diagnosis – the elimination diet challenge, the RAST (radioallergosorbent test), and a skin test.

The elimination diet challenge is the most accurate and reliable way to test for a food allergy. Your doctor will tell you to avoid nut-containing foods for a period of time to see if your symptoms disappear. You will then be asked to resume eating nut-containing foods to see if your symptoms come back. If they do, there is a good chance that you do have a nut allergy. Make sure to avoid not only nuts, but certain breakfast cereals, cakes, biscuits, and other sweets (for example, baklava). Foods cooked in nut oils should also be avoided – when cooking at home, avoid using ground nut oils, and ask when eating out.

The RAST (radioallergosorbent test) is also fairly accurate and reliable. It involves taking blood, and attempting to react IgE in your blood with nut allergens. IgE is the immune chemical that stimulates mast cell (a type of white blood cell) to make histamine, which is the chemical causing your signs and symptoms. Skin tests are done by introducing a small amount of allergen to the skin or just under the skin to see if a skin reaction develops. If you are allergic to tree nuts, you might see a “wheal and flare” - an irregular, blanched area of skin surrounded by a reddened area of inflammation. Your doctor might not decide to do a skin test if you are extremely allergic or have had episodes of anaphylaxis, in case it triggers another episode of anaphylactic shock.

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