Component Testing for Food Allergy

This document focuses on the addition of guideline-supported component testing to positive whole crude allergen tests.

Component testing for food allergy

Topic Brief

Component testing for food allergy

Introduction

In 2021, the percentage of children in the United States with food allergy was approximately 6% as reported by the Centers for Disease Control and Prevention.¹ Allergies develop when a person has produced IgE antibody (ie, is sensitized) to specific food component proteins on initial exposure and then has a reaction after being re-exposed to the same food. A reaction can also occur when these IgE antibodies cross-react with similar component proteins in a different food. However, some children may be only sensitized to an antigen without having a true allergy.

A true allergic reaction to a food is also called an IgE-mediated (ie, type I) hypersensitivity reaction. Symptoms occur within seconds of exposure to a food or food group and can be severe; in rare cases, the reaction is fatal. Importantly, some individuals who are IgE-sensitized to a food will not develop symptoms if the food is ingested again.² Therefore, patients with positive IgE test results for a specific food fall into 2 categories: (1) IgE-sensitized and allergic and (2) IgE-sensitized but not allergic. While whole-food IgE testing may not distinguish between these 2 groups of patients, food component IgE testing detects IgE to different proteins within a food and can help better differentiate whether or not an IgE-sensitized patient has a true allergy.^3,4

Diagnostic testing

For patients with suspected food allergies (eg, peanut, tree nuts, milk, eggs), serum IgE tests or skin prick tests (SPTs) are recommended.⁵ Testing should focus on foods suspected of provoking a reaction or which have been recently ingested and should be used in conjunction with the patient’s clinical history (eg, recent ingestion, clinical reaction).⁶

Serum IgE tests and SPTs are standard diagnostic tests, but these methods do not reliably distinguish IgE sensitization from true allergy. In peanuts, for example, a substantial overlap is observed in the distribution of peanut-specific IgE levels of sensitized patients with and without a true peanut allergy.⁷ The oral food challenge (OFC), considered the gold standard in diagnostic testing for food allergies, can help diagnose food allergies if a clinical history or test results are insufficient to establish a diagnosis; however, OFC is expensive and puts the patient at risk for an anaphylactic reaction.⁸

Component testing can distinguish patients with a true food allergy from those who are only IgE-sensitized, without the risk of anaphylactic shock from an OFC.^4,6 Depending on the specific component targets(s) of IgE reactivity (Table 1),^9-15 a patient may be at low, variable, or high risk of a true allergy to the food of concern.

Table 1. Whole Food and Components

Whole food	Component proteins	Meaning of positive IgE reaction (component IgE profiles)^9-15
Peanut	Ara h 1, 2, 3, 6	Ara h 2 is nearly always associated with clinical allergy; presence of any of these 4 components indicates high risk of systemic reaction including anaphylaxis
	Ara h 9	Variable risk of strong allergic reaction (often accompanied by sensitization to other peanut proteins)
	Ara h 8	Low risk of systemic reactions Associated with local reactions or no reaction at all
Tree nuts Hazelnut Cashew Brazil nut Walnut	Cor a 9,14 Cashew Ana o 3 Brazil nut Ber e 1 Walnut Jug r 1	Presence of any of these 5 components indicates high risk of systemic reactions including anaphylaxis
	Hazelnut Cor a 8 Walnut Jug r 3	Associated with mild local reactions, as well as systemic reactions
	Hazelnut Cor a 1	Low risk of systemic reactions Associated with local reactions or no reaction at all
Milk	Casein (protein stable when heated)	High risk of reaction to all forms of cow’s milk
Milk	α-lactalbumin and β-lactoglobulin (proteins unstable when heated)	High risk of reaction to fresh cow’s milk Low risk of reaction to baked foods containing milk
Egg	Ovomucoid (protein stable when heated)	High risk of reaction to all forms of egg
Egg	Ovalbumin (protein unstable when heated)	High risk of reaction to fresh eggs Low risk of reaction to baked eggs

Structural similarities of proteins within food families may cause IgE cross-reactivity. Consequently, component testing can help determine the likelihood that a patient who is allergic to one food will also react to other potentially cross-reactive foods.

Component testing examples

Tree nuts and peanuts

Different nut component proteins may elicit systemic reactions, local reactions, or no reaction at all, depending on their resistance to heat and enzymatic digestion.^16,17 In peanuts, for example, storage proteins (eg, Ara h 1, Ara h 2, Ara h 3, Ara h 6) are resistant to digestion and can trigger systemic reactions (most commonly Ara h 2), whereas PR-10 (eg, Ara h 8) is heat- and digestion-labile. IgE reactivity to PR-10 alone usually results in no or local reactions (Table 2).^18,19 Therefore, IgE reactivity to Ara h 1-3, and/or 6 supports a diagnosis of a true peanut allergy and may require dietary restrictions and anaphylaxis precautions during meals, while sensitization to Ara h 8 alone would suggest a low risk for a true peanut allergy, and continued peanut consumption would likely be appropriate.²⁰

Table 2. Component Protein Families in Tree Nuts and Peanuts

Protein family	Component protein	Source	Stability	Cross-reactivity to IgE^18,19
Storage protein	Ana o 3 Ara h 1, Ara h 2, Ara h 3, Ara h 6 Ber e 1 Cor a 9, Cor a 14 Jug r 1	Brazil nut, cashew, hazelnut, peanut, walnut	Stable to both heat and digestion; therefore, can cause systemic reactions	Relatively species-specific
Lipid transfer protein	Ara h 9 Cor a 8 Jug r 3 Pru p 3	Hazelnut, peanut	Stable to heat and digestion; therefore, can cause systemic reactions	Varies
PR-10 protein	Ara h 8 Bet v 1 Cor a 1 Mal d 1	Hazelnut, peanut	Heat and digestion labile. Primarily causes local clinical reactions	Varies
Profilin	Ara h 5 Bet v 2 Cor a 2 Gly m 3 Phl p 12	Brazil nut, cashew, hazelnut, peanut, walnut	Heat and digestion labile. Primarily causes no or local clinical reactions	Extensive

The structural similarities of proteins throughout the plant kingdom also affect their potential for IgE cross-reactivity (Table 2).²¹ For example, walnuts, pecans, and hazelnuts form a group of strongly cross-reactive tree nuts²²; thus, an individual with IgE to allergenic components in walnuts can also be allergic to pecans and hazelnuts. IgE cross-reactivity also explains why individuals can have IgE to certain foods, such as peanuts and tree nuts, but not exhibit true allergy. Exposure to profilin or bromelain and its cross-reactive carbohydrate determinant (CCD) MUXF3—found throughout the plant kingdom—can cause sensitization, but these allergens are not associated with true allergy.²³

By identifying specific protein components that are common among certain nut or plant species, component testing may help guide dietary restrictions to include or exclude foods based on the potential for allergic reactions due to IgE cross-reactivity.

Milk and eggs

In their native conformations, milk and egg proteins may cause mild to severe allergic reactions in IgE-sensitized patients (Table 1).^21,24 Patients with IgE reactivity to milk and egg proteins that are resistant to heat or digestion (eg, casein, ovomucoid) are most likely to have allergic reactions to these foods. However, many patients who are IgE-sensitized primarily to heat-labile milk and/or egg component proteins (eg, α-lactalbumin, β-lactoglobulin, ovalbumin) can tolerate eggs and/or milk in baked goods even though they react to these foods when uncooked or undiluted by other ingredients.²⁵

Test availability

Quest Diagnostics offers whole-food IgE testing with reflex to components if whole-food IgE testing is positive for certain foods (Appendix).

References

Diagnosed Allergic Conditions in Children Aged 0-17 Years: United States, 2021. Centers for Disease Control and Prevention. Updated January 25, 2023. Accessed July 30, 2025. https://www.cdc.gov/nchs/products/databriefs/db459.htm#:~:text=Health%20Interview%20Survey-,In%202021%2C%20just%20over%20one%2Dquarter%20of%20children%20in%20the,5.8%25)%20(Figure%201).
Lieberman JA, Sicherer SH. Diagnosis of food allergy: epicutaneous skin tests, in vitro tests, and oral food challenge. Curr Allergy Asthma Rep. 2011;11(1):58-64. doi:10.1007/s11882-010-0149-4
Roberts G, Ollert M, Aalberse R, et al. A new framework for the interpretation of IgE sensitization tests. Allergy. 2016;71(11):1540-1551. doi:10.1111/all.12939
Kattan JD, Sicherer SH. Optimizing the diagnosis of food allergy. Immunol Allergy Clin North Am. 2015;35(1):61-76. doi:10.1016/j.iac.2014.09.009
Boyce JA, Assa'ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6 Suppl):S1-58. doi:10.1016/j.jaci.2010.10.007
Sampson HA, Aceves S, Bock SA, et al. Food allergy: a practice parameter update—2014. J Allergy Clin Immunol. 2014;134(5):1016-1025.e1043. doi:10.1016/j.jaci.2014.05.013
van Veen WJ, Dikkeschei LD, Roberts G, et al. Predictive value of specific IgE for clinical peanut allergy in children: relationship with eczema, asthma, and setting (primary or secondary care). Clin Transl Allergy. 2013;3(1):34. doi:10.1186/2045-7022-3-34
Yanagida N, Sato S, Takahashi K, et al. Risk of anaphylaxis during an oral food challenge increases with increasing specific IgE levels. J Allergy Clin Immunol. 2018;141(2)(suppl):AB151. doi:10.1016/j.jaci.2017.12.484
Canonica GW, Ansotegui IJ, Pawankar R, et al. A WAO - ARIA - GA²LEN consensus document on molecular-based allergy diagnostics. World Allergy Organ J. 2013;6(1):1-17. doi:10.1186/1939-4551-6-17
Kleine-Tebbe J, Jakob T, eds. Molecular Allergy Diagnostics: Innovation for a Better Patient Management. Springer International Publishing; 2017:1-531.
Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, et al. EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol. 2016;27(S23):1-250. doi:10.1111/pai.12563
Sastre J. Molecular diagnosis in allergy. Clin Exp Allergy. 2010;40(10):1442-1460. doi:10.1111/j.1365-2222.2010.03585.x
Treudler R, Simon JC. Overview of component resolved diagnostics. Curr Allergy Asthma Rep. 2013;13(1):110-117. doi:10.1007/s11882-012-0318-8
Abrams EM, Chan ES, Sicherer S. Peanut allergy: new advances and ongoing controversies. Pediatrics. 2020;145(5.e20192102)doi:10.1542/peds.2019-2102
Steering Committee Authors; Review Panel Members. A WAO - ARIA - GA(2)LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020. World Allergy Organ J. 2020;13(2):100091. doi:10.1016/j.waojou.2019.100091
Traidl-Hoffmann C, Jakob T, Behrendt H. Determinants of allergenicity. J Allergy Clin Immunol. 2009;123(3):558-566. doi:10.1016/j.jaci.2008.12.003
Chruszcz M, Kapingidza AB, Dolamore C, et al. A robust method for the estimation and visualization of IgE cross-reactivity likelihood between allergens belonging to the same protein family. PLoS One. 2018;13(11):e0208276. doi:10.1371/journal.pone.0208276
Eiwegger T, Rigby N, Mondoulet L, et al. Gastro-duodenal digestion products of the major peanut allergen Ara h 1 retain an allergenic potential. Clin Exp Allergy. 2006;36(10):1281-1288. doi:10.1111/j.1365-2222.2006.02565.x
Blankestijn MA, Knulst AC, Knol EF, et al. Sensitization to PR-10 proteins is indicative of distinctive sensitization patterns in adults with a suspected food allergy. Clin Transl Allergy. 2017;7:42. doi:10.1186/s13601-017-0177-4
Asarnoj A, Nilsson C, Lidholm J, et al. Peanut component Ara h 8 sensitization and tolerance to peanut. J Allergy Clin Immunol. 2012;130(2):468-472. doi:10.1016/j.jaci.2012.05.019
Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol. 2010;125(2)(Suppl 2):S116-125. doi:10.1016/j.jaci.2009.08.028
Goetz DW, Whisman BA, Goetz AD. Cross-reactivity among edible nuts: double immunodiffusion, crossed immunoelectrophoresis, and human specific igE serologic surveys. Ann Allergy Asthma Immunol. 2005;95(1):45-52. doi:10.1016/s1081-1206(10)61187-8
Lange L, Beyer K, Kleine-Tebbe J. Benefits and limitations of molecular diagnostics in peanut allergy: part 14 of the series Molecular Allergology. Allergo J Int. 2014;23(5):158-163. doi:10.1007/s40629-014-0019-z
Chokshi NY, Sicherer SH. Interpreting IgE sensitization tests in food allergy. Expert Rev Clin Immunol. 2016;12(4):389-403. doi:10.1586/1744666X.2016.1124761
Bloom KA, Huang FR, Bencharitiwong R, et al. Effect of heat treatment on milk and egg proteins allergenicity. Pediatr Allergy Immunol. 2014;25(8):740-746. doi:10.1111/pai.12283

Appendix

Food Allergy Panels and Tests^a,b

Test name	Test code
Brazil Nut (f18) IgE with Reflex to Component	94464
Cashew Nut (f202) IgE With Reflex to Component	94465
CCD (o214) IgE	39152
CCD and Profilin IgE Cross-Reactivity Panel	39151
Childhood Allergy (Food and Environmental) Profile With Reflexes Includes Alternaria alternata (m6, 2706), cat dander (e1, 10564) with reflex to cat components, Cladosporium herbarum (m2, 2702), cockroach (i6, 2736), codfish (f3, 2803), cow's milk (f2, 37900) with reflex to milk components, Dermatophagoides farinae (d2, 2722), Dermatophagoides pteronyssinus (d1, 2721), dog dander (e5, 10571) with reflex to dog components, egg white (f1, 37906) with reflex to egg components, mouse urine proteins (e72, 2658), peanut (f13, 91747) with reflex to peanut components, shrimp (f24, 2824), soybean (f14, 2814), walnut (f256, 3489), wheat (f4, 2804), and total IgE.	91683
Childhood and Tree Nut Allergy Panel With Reflex to Components Includes Alternaria alternata (m6, 2706), almond (f20, 2820), Brazil nut (f18, 94464) with reflex to Brazil nut components, cashew nut (f202, 94465) with reflex to cashew nut components, cat dander (e1, 10564) with reflex to cat components, Cladosporium herbarum (m2, 2702), cockroach (i6, 2736), codfish (f3, 2803), cow's milk (f2, 37900) with reflex to milk components, Dermatophagoides farinae (d2, 2722), Dermatophagoides pteronyssinus (d1, 2721), dog dander (e5, 10571) with reflex to dog components, egg white (f1, 37906) with reflex to egg components, hazelnut (f17, 94468) with reflex to hazelnut components, macadamia nut (rf345, 38475), mouse urine proteins (e72, 2658), peanut (f13, 91747) with reflex to peanut components, shrimp (f24, 2824), soybean (f14, 2814), walnut (f256, 94467) with reflex to walnut components, wheat (f4, 2804), and total IgE.	36766
Cow's Milk (f2) IgE With Reflex to Milk Component Panel	37900
Egg Component Panel Includes ovalbumin (f232) IgE, ovomucoid (f233) IgE	91372
Egg White (f1) IgE With Reflex to Egg Component Panel	37906
Food Allergy Profile With Reflexes Includes almond (f20, 2820), cashew nut (f202, 2608), codfish (F3, 2803), cow's milk (f2, 37900) with reflex to milk components, egg white (f1, 37906) with reflex to egg components, hazelnut (f17, 2817), peanut (f13, 91747) with reflex to peanut components, salmon (f41, 2841), scallop (f338, 273), sesame seed (f10, 2810), shrimp (f24, 2824), soybean (f14, 2814), tuna (f40, 2840), walnut (f256, 2804), and wheat (f4, 2804) IgE.	91682
Food and Tree Nut Allergy Panel With Reflex to Components Includes almond (f20, 2820), Brazil nut (f18, 94464) with reflex to Brazil nut components, cashew nut (f202, 94465), with reflex to cashew nut components, codfish (f3, 2803), cow's milk (f2, 37900) with reflex to milk components, egg white (f1, 37906) with reflex to egg components, hazelnut (f17, 94468) with reflex to hazelnut components, macadamia nut (rf345, 38475), peanut (f13, 91747) with reflex to peanut components, salmon (f41, 2841), scallop (f338, 273), sesame seed (f10, 2810), shrimp (f24, 2824), soybean (f14, 2814), tuna (f40, 2840), walnut (f256, 94467) with reflex to walnut components, and wheat (f4, 2804) IgE.	36763
Hazelnut (f17) IgE With Reflex to Component	94468
Hazelnut Component Panel Includes Cor a1 (f428), Cor a8 (f425), Cor a9 (f440), Cor a14 (f439)	94476
Milk Component Panel Includes alpha-lactalbumin (f76) IgE, beta-lactoglobulin (f77) IgE, casein (f78) IgE	91403
Peanut Component Panel	91681
Peanut, Total With Reflex to Peanut Component	91747
Profilin (t216) IgE	39153
Tree Nut Allergy Panel With Reflex to Components Includes almond (f20, 2820), Brazil nut (f18, 94464) with reflex to Brazil nut components, cashew nut (f202, 94465) with reflex to cashew nut components, hazelnut (f17, 94468) with reflex to hazelnut components, macadamia nut (rf345, 38475), peanut (f13, 91747) with reflex to peanut components, pecan (f201, 2864), pistachio (f203, 2726), and walnut (f256, 94467) IgE with reflex to walnut components	94463
Walnut Component Panel Includes rJug r1 (f441), rJug r3 (f442)	94472
Walnut (f256) IgE With Reflex to Component	94467

^a	Reflex tests are performed at an additional charge and are associated with an additional CPT® code(s). CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.
^b	Component panels or tests can be ordered separately.

Content reviewed 9/2025

top of page

This document focuses on the addition of guideline-supported component testing to positive whole crude allergen tests.

Test Guide List

Component testing for food allergy

Topic Brief

Component testing for food allergy

Introduction

Diagnostic testing

Table 1. Whole Food and Components

Whole food	Component proteins	Meaning of positive IgE reaction (component IgE profiles)^9-15
Peanut	Ara h 1, 2, 3, 6	Ara h 2 is nearly always associated with clinical allergy; presence of any of these 4 components indicates high risk of systemic reaction including anaphylaxis
	Ara h 9	Variable risk of strong allergic reaction (often accompanied by sensitization to other peanut proteins)
	Ara h 8	Low risk of systemic reactions Associated with local reactions or no reaction at all
Tree nuts Hazelnut Cashew Brazil nut Walnut	Cor a 9,14 Cashew Ana o 3 Brazil nut Ber e 1 Walnut Jug r 1	Presence of any of these 5 components indicates high risk of systemic reactions including anaphylaxis
	Hazelnut Cor a 8 Walnut Jug r 3	Associated with mild local reactions, as well as systemic reactions
	Hazelnut Cor a 1	Low risk of systemic reactions Associated with local reactions or no reaction at all
Milk	Casein (protein stable when heated)	High risk of reaction to all forms of cow’s milk
Milk	α-lactalbumin and β-lactoglobulin (proteins unstable when heated)	High risk of reaction to fresh cow’s milk Low risk of reaction to baked foods containing milk
Egg	Ovomucoid (protein stable when heated)	High risk of reaction to all forms of egg
Egg	Ovalbumin (protein unstable when heated)	High risk of reaction to fresh eggs Low risk of reaction to baked eggs

Component testing examples

Tree nuts and peanuts

Table 2. Component Protein Families in Tree Nuts and Peanuts

Protein family	Component protein	Source	Stability	Cross-reactivity to IgE^18,19
Storage protein	Ana o 3 Ara h 1, Ara h 2, Ara h 3, Ara h 6 Ber e 1 Cor a 9, Cor a 14 Jug r 1	Brazil nut, cashew, hazelnut, peanut, walnut	Stable to both heat and digestion; therefore, can cause systemic reactions	Relatively species-specific
Lipid transfer protein	Ara h 9 Cor a 8 Jug r 3 Pru p 3	Hazelnut, peanut	Stable to heat and digestion; therefore, can cause systemic reactions	Varies
PR-10 protein	Ara h 8 Bet v 1 Cor a 1 Mal d 1	Hazelnut, peanut	Heat and digestion labile. Primarily causes local clinical reactions	Varies
Profilin	Ara h 5 Bet v 2 Cor a 2 Gly m 3 Phl p 12	Brazil nut, cashew, hazelnut, peanut, walnut	Heat and digestion labile. Primarily causes no or local clinical reactions	Extensive

Milk and eggs

Test availability

Quest Diagnostics offers whole-food IgE testing with reflex to components if whole-food IgE testing is positive for certain foods (Appendix).

References

Diagnosed Allergic Conditions in Children Aged 0-17 Years: United States, 2021. Centers for Disease Control and Prevention. Updated January 25, 2023. Accessed July 30, 2025. https://www.cdc.gov/nchs/products/databriefs/db459.htm#:~:text=Health%20Interview%20Survey-,In%202021%2C%20just%20over%20one%2Dquarter%20of%20children%20in%20the,5.8%25)%20(Figure%201).
Lieberman JA, Sicherer SH. Diagnosis of food allergy: epicutaneous skin tests, in vitro tests, and oral food challenge. Curr Allergy Asthma Rep. 2011;11(1):58-64. doi:10.1007/s11882-010-0149-4
Roberts G, Ollert M, Aalberse R, et al. A new framework for the interpretation of IgE sensitization tests. Allergy. 2016;71(11):1540-1551. doi:10.1111/all.12939
Kattan JD, Sicherer SH. Optimizing the diagnosis of food allergy. Immunol Allergy Clin North Am. 2015;35(1):61-76. doi:10.1016/j.iac.2014.09.009
Boyce JA, Assa'ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6 Suppl):S1-58. doi:10.1016/j.jaci.2010.10.007
Sampson HA, Aceves S, Bock SA, et al. Food allergy: a practice parameter update—2014. J Allergy Clin Immunol. 2014;134(5):1016-1025.e1043. doi:10.1016/j.jaci.2014.05.013
van Veen WJ, Dikkeschei LD, Roberts G, et al. Predictive value of specific IgE for clinical peanut allergy in children: relationship with eczema, asthma, and setting (primary or secondary care). Clin Transl Allergy. 2013;3(1):34. doi:10.1186/2045-7022-3-34
Yanagida N, Sato S, Takahashi K, et al. Risk of anaphylaxis during an oral food challenge increases with increasing specific IgE levels. J Allergy Clin Immunol. 2018;141(2)(suppl):AB151. doi:10.1016/j.jaci.2017.12.484
Canonica GW, Ansotegui IJ, Pawankar R, et al. A WAO - ARIA - GA²LEN consensus document on molecular-based allergy diagnostics. World Allergy Organ J. 2013;6(1):1-17. doi:10.1186/1939-4551-6-17
Kleine-Tebbe J, Jakob T, eds. Molecular Allergy Diagnostics: Innovation for a Better Patient Management. Springer International Publishing; 2017:1-531.
Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, et al. EAACI Molecular Allergology User's Guide. Pediatr Allergy Immunol. 2016;27(S23):1-250. doi:10.1111/pai.12563
Sastre J. Molecular diagnosis in allergy. Clin Exp Allergy. 2010;40(10):1442-1460. doi:10.1111/j.1365-2222.2010.03585.x
Treudler R, Simon JC. Overview of component resolved diagnostics. Curr Allergy Asthma Rep. 2013;13(1):110-117. doi:10.1007/s11882-012-0318-8
Abrams EM, Chan ES, Sicherer S. Peanut allergy: new advances and ongoing controversies. Pediatrics. 2020;145(5.e20192102)doi:10.1542/peds.2019-2102
Steering Committee Authors; Review Panel Members. A WAO - ARIA - GA(2)LEN consensus document on molecular-based allergy diagnosis (PAMD@): Update 2020. World Allergy Organ J. 2020;13(2):100091. doi:10.1016/j.waojou.2019.100091
Traidl-Hoffmann C, Jakob T, Behrendt H. Determinants of allergenicity. J Allergy Clin Immunol. 2009;123(3):558-566. doi:10.1016/j.jaci.2008.12.003
Chruszcz M, Kapingidza AB, Dolamore C, et al. A robust method for the estimation and visualization of IgE cross-reactivity likelihood between allergens belonging to the same protein family. PLoS One. 2018;13(11):e0208276. doi:10.1371/journal.pone.0208276
Eiwegger T, Rigby N, Mondoulet L, et al. Gastro-duodenal digestion products of the major peanut allergen Ara h 1 retain an allergenic potential. Clin Exp Allergy. 2006;36(10):1281-1288. doi:10.1111/j.1365-2222.2006.02565.x
Blankestijn MA, Knulst AC, Knol EF, et al. Sensitization to PR-10 proteins is indicative of distinctive sensitization patterns in adults with a suspected food allergy. Clin Transl Allergy. 2017;7:42. doi:10.1186/s13601-017-0177-4
Asarnoj A, Nilsson C, Lidholm J, et al. Peanut component Ara h 8 sensitization and tolerance to peanut. J Allergy Clin Immunol. 2012;130(2):468-472. doi:10.1016/j.jaci.2012.05.019
Sicherer SH, Sampson HA. Food allergy. J Allergy Clin Immunol. 2010;125(2)(Suppl 2):S116-125. doi:10.1016/j.jaci.2009.08.028
Goetz DW, Whisman BA, Goetz AD. Cross-reactivity among edible nuts: double immunodiffusion, crossed immunoelectrophoresis, and human specific igE serologic surveys. Ann Allergy Asthma Immunol. 2005;95(1):45-52. doi:10.1016/s1081-1206(10)61187-8
Lange L, Beyer K, Kleine-Tebbe J. Benefits and limitations of molecular diagnostics in peanut allergy: part 14 of the series Molecular Allergology. Allergo J Int. 2014;23(5):158-163. doi:10.1007/s40629-014-0019-z
Chokshi NY, Sicherer SH. Interpreting IgE sensitization tests in food allergy. Expert Rev Clin Immunol. 2016;12(4):389-403. doi:10.1586/1744666X.2016.1124761
Bloom KA, Huang FR, Bencharitiwong R, et al. Effect of heat treatment on milk and egg proteins allergenicity. Pediatr Allergy Immunol. 2014;25(8):740-746. doi:10.1111/pai.12283

Appendix

Food Allergy Panels and Tests^a,b

Test name	Test code
Brazil Nut (f18) IgE with Reflex to Component	94464
Cashew Nut (f202) IgE With Reflex to Component	94465
CCD (o214) IgE	39152
CCD and Profilin IgE Cross-Reactivity Panel	39151
Childhood Allergy (Food and Environmental) Profile With Reflexes Includes Alternaria alternata (m6, 2706), cat dander (e1, 10564) with reflex to cat components, Cladosporium herbarum (m2, 2702), cockroach (i6, 2736), codfish (f3, 2803), cow's milk (f2, 37900) with reflex to milk components, Dermatophagoides farinae (d2, 2722), Dermatophagoides pteronyssinus (d1, 2721), dog dander (e5, 10571) with reflex to dog components, egg white (f1, 37906) with reflex to egg components, mouse urine proteins (e72, 2658), peanut (f13, 91747) with reflex to peanut components, shrimp (f24, 2824), soybean (f14, 2814), walnut (f256, 3489), wheat (f4, 2804), and total IgE.	91683
Childhood and Tree Nut Allergy Panel With Reflex to Components Includes Alternaria alternata (m6, 2706), almond (f20, 2820), Brazil nut (f18, 94464) with reflex to Brazil nut components, cashew nut (f202, 94465) with reflex to cashew nut components, cat dander (e1, 10564) with reflex to cat components, Cladosporium herbarum (m2, 2702), cockroach (i6, 2736), codfish (f3, 2803), cow's milk (f2, 37900) with reflex to milk components, Dermatophagoides farinae (d2, 2722), Dermatophagoides pteronyssinus (d1, 2721), dog dander (e5, 10571) with reflex to dog components, egg white (f1, 37906) with reflex to egg components, hazelnut (f17, 94468) with reflex to hazelnut components, macadamia nut (rf345, 38475), mouse urine proteins (e72, 2658), peanut (f13, 91747) with reflex to peanut components, shrimp (f24, 2824), soybean (f14, 2814), walnut (f256, 94467) with reflex to walnut components, wheat (f4, 2804), and total IgE.	36766
Cow's Milk (f2) IgE With Reflex to Milk Component Panel	37900
Egg Component Panel Includes ovalbumin (f232) IgE, ovomucoid (f233) IgE	91372
Egg White (f1) IgE With Reflex to Egg Component Panel	37906
Food Allergy Profile With Reflexes Includes almond (f20, 2820), cashew nut (f202, 2608), codfish (F3, 2803), cow's milk (f2, 37900) with reflex to milk components, egg white (f1, 37906) with reflex to egg components, hazelnut (f17, 2817), peanut (f13, 91747) with reflex to peanut components, salmon (f41, 2841), scallop (f338, 273), sesame seed (f10, 2810), shrimp (f24, 2824), soybean (f14, 2814), tuna (f40, 2840), walnut (f256, 2804), and wheat (f4, 2804) IgE.	91682
Food and Tree Nut Allergy Panel With Reflex to Components Includes almond (f20, 2820), Brazil nut (f18, 94464) with reflex to Brazil nut components, cashew nut (f202, 94465), with reflex to cashew nut components, codfish (f3, 2803), cow's milk (f2, 37900) with reflex to milk components, egg white (f1, 37906) with reflex to egg components, hazelnut (f17, 94468) with reflex to hazelnut components, macadamia nut (rf345, 38475), peanut (f13, 91747) with reflex to peanut components, salmon (f41, 2841), scallop (f338, 273), sesame seed (f10, 2810), shrimp (f24, 2824), soybean (f14, 2814), tuna (f40, 2840), walnut (f256, 94467) with reflex to walnut components, and wheat (f4, 2804) IgE.	36763
Hazelnut (f17) IgE With Reflex to Component	94468
Hazelnut Component Panel Includes Cor a1 (f428), Cor a8 (f425), Cor a9 (f440), Cor a14 (f439)	94476
Milk Component Panel Includes alpha-lactalbumin (f76) IgE, beta-lactoglobulin (f77) IgE, casein (f78) IgE	91403
Peanut Component Panel	91681
Peanut, Total With Reflex to Peanut Component	91747
Profilin (t216) IgE	39153
Tree Nut Allergy Panel With Reflex to Components Includes almond (f20, 2820), Brazil nut (f18, 94464) with reflex to Brazil nut components, cashew nut (f202, 94465) with reflex to cashew nut components, hazelnut (f17, 94468) with reflex to hazelnut components, macadamia nut (rf345, 38475), peanut (f13, 91747) with reflex to peanut components, pecan (f201, 2864), pistachio (f203, 2726), and walnut (f256, 94467) IgE with reflex to walnut components	94463
Walnut Component Panel Includes rJug r1 (f441), rJug r3 (f442)	94472
Walnut (f256) IgE With Reflex to Component	94467

^a	Reflex tests are performed at an additional charge and are associated with an additional CPT® code(s). CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payer being billed.
^b	Component panels or tests can be ordered separately.

Content reviewed 9/2025

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Test Code 10571

Dog Dander (e5) IgE with Reflex to Component Panel

Like respiratory allergies, animal allergies pose a significant risk for the development of asthma and rhinitis. Blood IgE tests using whole allergen extracts from dogs provide a sensitive screening method to diagnose pet sensitization. In addition, the dog dander component panel is an IgE blood test using individual recombinant proteins from dogs, improving specificity compared to animal extract assays. Thus, the dog dander component panel helps differentiate an actual dog allergy from a cross-

Test Code 10564

Cat Dander (e1) IgE with Reflex to Component Panel

Like respiratory allergies, animal allergies pose a significant risk for the development of asthma and rhinitis. Blood IgE tests using whole allergen extracts from cats provide a sensitive screening method to diagnose pet sensitization. In addition, the cat dander component panel is an IgE blood test using individual recombinant proteins from cats, improving specificity compared to animal extract assays. Thus, the cat dander component panel helps differentiate an actual cat allergy from a cross-

Test Code 2608

Cashew Nut (f202) IgE

This test detects the presence of specific IgE against cashew nuts. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 2658

Mouse Urine Proteins (e72) IgE

This test quantifies an individual's IgE response to mouse urine proteins. Allergen-specific serum IgE testing is considered comparable to skin testing and may be preferred in some clinical situations. However, a positive test result only indicates that a patient is sensitized to the allergen of concern. Many IgE-sensitized individuals do not develop any symptoms when exposed to the allergen. A diagnosis of allergy should only be made by a trained medical provider after conducting a thorough cli

Test Code 2726

Pistachio (f203) IgE

This test detects the presence of specific IgE against pistachios. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 2736

Cockroach (i6) IgE

This allergen-specific IgE antibody test quantifies an individual's IgE response to German cockroach, an insect commonly found in urban environments with temperate climates. Exposure to cockroach allergens is associated with asthma, especially among children and young adults [1]. This test is an in vitro quantitative assay that is intended to be used in conjunction with other clinical information to aid in the diagnosis of allergic diseases [2].

While allergen-specific serum IgE testing

Test Code 273

Scallop (f338) IgE

This test detects the presence of specific IgE against scallops. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 2722

Dermatophagoides farinae (d2) IgE

This test detects the presence of specific IgE against Dermatophagoides farinae. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 2864

Pecan Nut (f201) IgE

This test detects the presence of specific IgE against pecan nuts. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 2702

Cladosporium herbarum (m2) IgE

This allergen-specific IgE antibody test quantifies an individual’s IgE response to Cladosporium herbarum. It is an in vitro quantitative assay that is intended to be used in conjunction with other clinical information to aid in the diagnosis of allergic diseases [1].

While allergen-specific serum IgE testing is considered comparable to skin testing in many instances, both the American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, A

Test Code 2804

Wheat (f4) IgE

This test detects the presence of specific IgE against wheat. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 2820

Almond (f20) IgE

This test detects the presence of specific IgE against almonds. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 2840

Tuna (f40) IgE

This test detects the presence of specific IgE against tuna. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 36766

Childhood and Tree Nut Allergy Panel with Reflex to Components

Up to 90 percent of children with asthma have underlying allergies that trigger their asthma [1,2]. Many things like environmental and food elements can trigger allergic reactions in children. Specific IgE serological tests aid in the diagnosis of allergic disease. In this profile, when a whole allergen protein extract is found to be positive, the respective component panel, which uses individual recombinant or purified proteins, is automatically run. Component panels improve specificity, provid

Test Code 37906

Egg White (f1) IgE with Reflex to Egg Component Panel

Patients with positive allergen IgE results may not have a true food allergy. Food component IgE tests offer more specific information to better predict the likelihood that a true food allergy exists and other details of potential clinical relevance.

Test Code 39151

CCD and Profilin IgE Cross-Reactivity Panel

The CCD/Profilin IgE cross-reactivity panel can be used by clinicians interested in understanding why a patient with IgE to whole peanut and/or tree nut is not allergic to these foods. CCD and Profilin-specific IgE, while highly cross-reactive with whole nuts, is not associated with a true allergy to them. The CCD/profilin IgE cross-reactivity panel may also be ordered by clinicians for follow up testing if a patient?s peanut and/or tree nut IgE component panel results are completely negative.

Test Code 39153

Profilin (t216) IgE

Profilins are found in pollens from trees, grasses, weeds, fruits, vegetables, nuts, spices, and latex. IgE reactivity to profilins contributes significantly to IgE cross-reactivity between trees, grasses, and weeds. Since profilins are also known to be heat and protease sensitive, profilin specific IgE is an important trigger for oral allergy syndrome: A mild, short lived, oral reaction, occurring immediately after the ingestion of raw fruits, vegetables, and nuts. This syndrome is more commonl

Test Code 91403

Milk Component Panel

For use in the identification and severity of which specific milk protein a patient is allergic. This knowledge enables the clinician and the patient to make the correct treatment and lifestyle choices to mitigate exposure and reaction risk.

Test Code 2706

Alternaria alternata (m6) IgE

This test detects the presence of specific IgE against Alternaria alternata. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 2721

Dermatophagoides pteronyssinus (d1) IgE

This allergen-specific IgE antibody test quantifies an individual's IgE response to Dermatophagoides pteronyssinus, a species of house dust mites that can cause atopic reactivity and allergic disease affecting the eyes, airways, skin, and occasionally the circulation [1]. This test is an in vitro quantitative assay that is intended to be used in conjunction with other clinical information to aid in the diagnosis of allergic diseases [2].

While allergen-specific serum IgE testing

Test Code 2810

Sesame Seed (f10) IgE

This test detects the presence of specific IgE against sesame seeds. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 2803

Codfish (f3) IgE

This test detects the presence of specific IgE against codfish. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 94463

Tree Nut Allergy Panel with Reflex to Components

This panel tests for specific IgE antibodies to 9 nuts that are commonly associated with allergies. The corresponding allergen component panel will be performed if IgE result for Brazil nuts, cashew nuts, hazelnuts, peanuts, or walnuts is positive. Allergen-specific serum IgE testing is considered comparable to skin testing and may be preferred in some clinical situations. However, a positive test result only indicates that a patient is sensitized to the allergen of concern. Many IgE-sensitized

Test Code 2817

Hazelnut (f17) IgE

This test detects the presence of specific IgE against hazelnuts. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 2841

Salmon (f41) IgE

This test detects the presence of specific IgE against salmon. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 2824

Shrimp (f24) IgE

This test detects the presence of specific IgE against shrimp. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 2814

Soybean (f14) IgE

This test detects the presence of specific IgE against soybeans. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 36763

Food and Tree Nut Allergy Panel with Reflex to Components

This panel tests for specific IgE antibodies to 17 foods (with an emphasis on tree nuts) that are commonly associated with allergies. If the IgE result for cow's milk, egg whites, peanuts, Brazil nuts, walnuts, cashew nuts, or hazelnuts is positive, the corresponding allergen component panel will be performed. Allergen-specific serum IgE testing is considered comparable to skin testing and may be preferred in some clinical situations. However, a positive test result only indicates that a patient

Test Code 37900

Cow's Milk (f2) IgE with Reflex to Milk Component Panel

Test Code 38475

Macadamia Nut (rf345) IgE

This test detects the presence of specific IgE against macadamia nuts. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 3489

Walnut (f256) IgE

This test detects the presence of specific IgE against walnuts. A positive test only indicates that a person is sensitized and potentially allergic to this allergen. A diagnosis of allergy requires clinical signs and symptoms that appear to be associated with exposure to the allergen in addition to the detection of markers of IgE sensitization [1].

More specific information about this allergen can be found on the following website:

Test Code 39152

CCD (o214) IgE

CCD IgE reactivity, without reactivity to other allergen component proteins, helps to explain why many people with positive whole allergen IgE results are not truly allergic to the insect, food, or respiratory allergen of concern.

Test Code 91747

Peanut, Total with Reflex to Peanut Component Panel

The ImmunoCAP® Peanut IgE with Reflex allows patients to be screened for allergy to Peanuts. When the result is found to be positive, the ImmunoCAP® Peanut Component Test will automatically be run on the sample to determine which specific Peanut protein/s the patient has sensitivity to. In turn, this provides the clinician with more detailed information in order to assess the level of risk for life-threatening allergic reactions, and provide clarity regarding the patient's risk of an all

Test Code 94472

Walnut Component Panel

Whole food allergen IgE tests are very sensitive but some patients with positive results do not have a true food allergy. Food component IgE tests offer more specific information that better predicts the likelihood that a true food allergy exists and other details of potential clinical relevance. A final food allergy diagnosis should always be based on a combination of IgE test results, a physical examination, and clinical history.

Test Code 94476

Hazelnut Component Panel

Test Code 94467

Walnut (f256) IgE with Reflex to Component Panel

This test measures specific IgE antibodies to walnuts with reflex to a walnut component panel if the IgE result is positive. Allergen-specific serum IgE testing is considered comparable to skin testing and may be preferred in some clinical situations. However, a positive test result only indicates that a patient is sensitized to the allergen of concern. Many IgE-sensitized individuals do not develop any symptoms when exposed to the allergen. A diagnosis of allergy should only be made by a traine

Test Code 94468

Hazelnut (f17) IgE with Reflex to Component Panel

This test measures specific IgE antibodies to hazelnuts with reflex to a hazelnut component panel if the IgE result is positive. Allergen-specific serum IgE testing is considered comparable to skin testing and may be preferred in some clinical situations. However, a positive test result only indicates that a patient is sensitized to the allergen of concern. Many IgE-sensitized individuals do not develop any symptoms when exposed to the allergen. A diagnosis of allergy should only be made by a tr

Test Code 94464

Brazil Nut (f18) IgE with Reflex to Component

This test measures specific IgE antibodies to Brazil nuts with reflex to Brazil nut component Ber e 1 if the IgE result is positive. Allergen-specific serum IgE testing is considered comparable to skin testing and may be preferred in some clinical situations. However, a positive test result only indicates that a patient is sensitized to the allergen of concern. Many IgE-sensitized individuals do not develop any symptoms when exposed to the allergen. A diagnosis of allergy should only be made by

Test Code 94465

Cashew Nut (f202) IgE with Reflex to Component

This test measures specific IgE antibodies to cashew nuts with reflex to cashew nut component Ana o 3 if the IgE result is positive. Allergen-specific serum IgE testing is considered comparable to skin testing and may be preferred in some clinical situations. However, a positive test result only indicates that a patient is sensitized to the allergen of concern. Many IgE-sensitized individuals do not develop any symptoms when exposed to the allergen. A diagnosis of allergy should only be made by

Test Code 91372

Egg Component Panel

For use in the identification and severity of which specific egg protein a patient is allergic. This knowledge enables the clinician and the patient to make the correct treatment and lifestyle choices to mitigate exposure and reaction risk.

Test Code 91681

Peanut Component Panel

The ImmunoCAP® Peanut Component Allergen Test helps to assess a patient's level of risk of a life-threatening reaction, and may reassure patients when the risk for allergic symptoms is low or when they will most likely experience mild or localized reactions upon exposure to peanut. The test helps the health care provider identify primary, species-specific allergic sensitization, differentiate between symptoms caused by a primary allergen source and those caused by cross-reactivity, assess th

Test Code 91682

Food Allergy Profile with Reflexes

This in vitro allergen-specific IgE panel is used to quantitatively measure an individual's IgE response to 15 different foods that are commonly associated with allergies. These foods include almond, cashew nut, codfish, cow's milk, egg white, hazelnut, peanut, salmon, scallop, sesame seed, shrimp, soybean, tuna, walnut, and wheat. If the IgE result for egg white, cow's milk, or peanut is abnormal, the corresponding allergen component panel will be performed. This IgE panel is intended to be use

Test Code 91683

Childhood Allergy (Food and Environmental) Panel with Reflexes

Test Summary

Peanut Component Panel

This test is used to assess risk of severe allergic reaction vs mild or localized reaction to peanut exposure.

IG/Reference Manual

Test Guide List

This page is a complete list of Test Guides created by Quest Diagnostics.

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Reference ranges are provided as general guidance only. To interpret test results use the reference range in the laboratory report.

The tests listed by specialty and category are a select group of tests offered. For a complete list of Quest Diagnostics tests, please adjust the filter options chosen, or refer to our Directory of Services.

Component Testing for Food Allergy

Component Testing for Food Allergy

Topic Brief

Topic Brief

(43) Related Tests

(2) Related Guides