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Oral allergy Nausea Abdominal discomfort Throat tightness Urticaria generalized Angioedema Emesis Diarrhea Rhinoconjunctivitis Hoarseness Stridor Wheezing Specific IgE levels were compared before and after spiking, and in patients with a positive and negative DBPCFC using the Mann�CWhitney U-test. The diagnostic value of the sIgE and the SPT for the presence of hazelnut allergy was determined by calculating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for all patients, and before and after spiking. The positive predictive value and negative predictive value (PPV and NPV) were determined for different cutoff points of level of sIgE and size of the SPT. Levels of sIgE and sizes of SPT were compared between patients with a hazelnut allergy with subjective and objective Megestrol Acetate symptoms (using the Mann�CWhitney U-test), and between different grades according to Sampson using the Kruskal�CWallis test. The relation between a history of accidental ingestion leading to an allergic reaction to hazelnut and presence of hazelnut allergy was assessed by chi square. The presence of other atopic features in relation to a hazelnut allergy and sIgE levels was assessed by chi-square and Mann�CWhitney U-tests, respectively. All analyses were performed with SPSS (Version 15.0, SPSS Inc., Chicago, VEGFR inhibitor IL, USA). A total of 172 children underwent a DBPCFC for hazelnut between June 2004 and July 2010. One child was excluded owing to an inconclusive DBPCFC and 20 children were excluded, because it was unclear whether the level of sIgE was determined before or after spiking. Therefore, data of 151 children were analyzed. The DBPCFC confirmed a hazelnut allergy in 51 children (34%): 19 with subjective and 32 with objective symptoms. Table?2 presents the characteristics of the patients. Skin prick test for hazelnut and sIgE for birch pollen was not performed in all children (Table?2). Patient characteristics in these subgroups did not differ from the total patient group (not shown). The spiking increased the level of sIgE for hazelnut significantly (median UMI-77 3.3?kUA/l vs 8.5?kUA/l, P?=?0.019). Level of sIgE for hazelnut was significantly higher in the children with a hazelnut allergy than in children without a hazelnut allergy (median 26.7?kUA/l vs 2.6?kUA/l, P?