High Oral Challenge Success Rate in Almond-Sensitized Children

Overuse of non-specific nut allergy panel testing has led to unnecessary almond avoidance for many children when almond IgE levels are elevated, despite lack of exposure or reaction history. We hypothesized that children with almond sensitization without a history of prior exposure to almonds would tolerate almond oral challenge. This retrospective chart review looked at 28 pediatric patients who underwent an almond oral food challenge (OFC) at our center between January 2017 and April 2021. Patient characteristics, almond IgE levels, and challenge outcomes were compared between patients with and without previous almond exposure. Overall, 96% (27/28) of patients passed the almond OFC, with most patients reporting almond avoidance due to elevated peanut IgE levels and/or positive tree-nut panel testing conducted prior to seeing us in clinic. Almond IgE levels ranged from 0.35 to 17.20 IU/ml, without a notable difference between the levels of exposed and non-exposed groups. Children who are sensitized to almond without prior exposure have a very high likelihood of passing an almond challenge regardless of almond IgE levels. Pediatricians should refer their almond-avoidant patients for allergist-directed OFCs, as expanding a child’s diet early can significantly lessen school and mealtime anxiety and dramatically improve the quality of life for these children and their families.