Diagnostic accuracy of skin prick testing in children with tree nut allergy

To the Editor: We read with interest the article by Fleischer et al1 on the natural history of tree nut allergy, which demonstrated how allergists could be guided in selecting the appropriate timing for tree nut challenges based on predictive decision points for tree nut-specific serum IgE. SPTs to cashew, hazelnut, walnut, pecan, Brazil nut, and almond were performed using a single-lancet technique with commercial allergen extracts (Dome-Hollister-Stier, Spokane, Wash).5 Testing for pistachio nut and sesame seed (tahini) was performed by the prick-to-prick technique with fresh foods.5 Histamine (1 mg/mL) and a negative control solution were used for internal validation.