This narrative review article explores the unknowns regarding detection sensitivity required for testing foods for almond allergens, largely related to insufficient population-based threshold dose data.  The threshold dose empirically used in quality testing to detect allergens is typically less than 1 ppm as this threshold has been used for other potential allergens.  The authors explore existing quantitative dated related specifically to almonds relevant to label regulation and consumer protection.

Citations

• Mandalari G, Mackie AR. Almond allergy: an overview on prevalence, thresholds, regulations and allergen detection. 2018;10(11):1706.

Due to the high rate of false-positive skin-prick tests for almond allergy, it is important to explore the safety of oral food challenges in those with suspected sensitization.  Authors found a 94% (375/400) passed the oral food challenge, quantified by sIgE and skin prick wheal size, for those with suspected almond allergy, 4% (16/400) failed the oral food challenge, and 2% (9/400) had indeterminant reactions. This study found that anaphylaxis requiring epinephrine was rare (0.005%; 2/400 oral food challenge participants), and that pruritis was the most common symptom among those who experienced a reaction. Since almonds can serve as a popular source of nutrients for dairy-free or plant-based protein foods, oral food challenge may be feasible to help minimize potentially unnecessary avoidance of almonds.

Citations

• Baker MG, Kattan JD. Review of 400 consecutive oral food challenges to almond. Annal Allergy Asthma Immunol. 2019;122(2):189-92.