In the presence of a typical, supportive history of tree nut allergy, specific IgE results do not have to be over the known 95% positive predictive value for the diagnosis to be secure.

50 % of children with peanut allergy will develop tree nut allergy.

All peanut allergic children should avoid tree nuts from first diagnosis until tested for tree nuts using skin prick test or specific IgE.

Negatively tested tree nuts can be introduced to the home diet, but must be avoided in prepared foods and out of home meals to avoid contamination/substitution by peanut.

The introduction of tree nut to the infant diet should not be delayed hoping to prevent tree nut allergy as this has not been proven to be effective. It can be introduced at 4-6 months; whole nut carries a risk of choking.