Can I Eat Almond Extract with a Tree Nut Allergy?

I agree with Dr. James that almond extract and flavoring should be avoided if you are almond allergic but this brings up the question, are you really allergic to almond?

Many multiple tree nut allergic individuals are diagnosed by testing only.

How does this happen?  During the evaluation for a reaction to a tree nut or even peanut you may be tested to other tree nut (cashew, almond, pistachio, brazil nut, pecan and walnut). The results of the testing either by skin test or blood test may show positive reactions to many tree nuts.  One of them may be almond. 

There is a high false positive rate when testing to almond as illustrated below in an article in the Allergy literature in 2019 by Baker.

Annals of Allergy asthma and immunology Baker MG et al 2019;122:189.

94% of patients who were called allergic to almond passed a challenge (cut off for challenge of 5 mm on skin testing & 10 kU/L by blood test). There is an argument amongst Allergists that the false positive rate is so high that testing should not even be done with the exception if there is a history of a reaction occurred after eating almond.

SO WHO PASSED?

blood test: result less than  0.35 kU/L: 100% passed,    0.35 - 1.99 kU/L: 97% passed,   2 – 4.99 kU/L: 95.8% passed   

5 – 10 kU/L: 96.8%  passed and  greater than  10 kU/L: 86.4% passed.

Skin test results less than  5 mm raised area 97% passed,  reaction size of 6 – 8 mm: 92.6% passed and  greater than 9 mm: 81.8% passed.

Almond was probably the most over diagnosed tree nut allergy seen in my practice.

Conclusion: no history of an allergic reaction to almond and the diagnosis was made by testing only, please consider getting yourself challenged to almond in your Allergists office.   This will put your mind at ease.