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02, Table?4B). Level of sIgE and size of the SPT did not show a significant relation with the severity of the hazelnut allergy according to the Mueller classification (data not shown). Twenty-six percent of the children suspected of hazelnut allergy reported an accidental ingestion with allergic reaction to hazelnut in the history and resulted in a PPV of 59% for hazelnut allergy (P? http://www.selleckchem.com/products/LY294002.html the history had a significantly higher level of sIgE for hazelnut compared to children without atopic dermatitis in the history (median 6.8?kUA/l vs 1.35?kUA/l, P?=?0.007). This study showed a good NPV of diagnostic tests for hazelnut allergy in children that further improved by rCor a 1 spiking. However, the PPVs are moderate and decreased by spiking. The size of SPT was a better tool to diagnose hazelnut allergy also in combination with the level of sIgE. A history http://www.selleck.cn/products/wortmannin.html of accidental ingestion leading to allergic reaction attributed to the diagnostic work-up of hazelnut allergy in children. The function of a sIgE test is to detect serological reactivity to a specific allergen, whereas the diagnosis of food allergy is based on clinical criteria. However, sIgE for hazelnut is often used as a diagnostic test for hazelnut allergy. Cutoff levels for hazelnut sIgE with a 95% PPV could not be determined in this study nor in a previous study on hazelnut allergy [9]. Cutoff levels with a lower PPV than 90�C95% have limited decisive importance [17]. Specific IgE cutoff levels with 95% PPV could be established for other allergens as milk, egg, peanut, and walnut [18-20]. The inability of hazelnut sIgE to reach 95% PPV might be caused by the measurement http://www.selleckchem.com/products/CHIR-99021.html of birch pollen sIgE due to serological cross-reactivity. The effect of this serological cross-reactivity might be different between children and adults, because hazelnut allergy in children, even in a birch endemic area, may be partly pollen independent [2], in contrast to adults [12, 13, 21]. The spiking of the ImmunoCAP for hazelnut with rCor a 1 was aimed to increase the sensitivity of the test in birch pollen-related hazelnut allergy [22], and this was shown to be at the expense of a decreased specificity [12]. We evaluated the effect of spiking in two consecutive groups of children, with similar clinical characteristics (Table?2), selected before and after 2007. The spiking increased the level of sIgE for hazelnut significantly. This has already been shown before with consecutive measurements of the sIgE levels within one group of children in the USA [11].