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Blood Test Tracker

Almond IgE

Measures IgE antibodies to almond in your blood. A detectable result means your immune system has been sensitized to almond, which is not the same as an allergy.

AI-verified against cited sources. Awaiting expert reviewAlso called f20, f020LOINC 6019-4

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What it is

IgE is a type of antibody your immune system can make against a food protein. This test measures IgE to a whole almond extract using a method called ImmunoCAP (also written f20 or f020). Results come in kilounits per liter (kU/L), and many labs also print a class from 0 to 6. A level above your lab's cutoff means you are sensitized to almond. Sensitized people may or may not react when they eat it.

Why it matters

Almond is a tree nut, and allergy to tree nuts is more likely than milk or egg allergy to last into adulthood. This test can help you and your clinician look at which foods might be behind symptoms such as hives, stomach upset or mouth itching. On its own it cannot confirm an allergy, because many people with almond IgE eat almonds without trouble. Your history of symptoms matters most, and sometimes a supervised food challenge is the way to find out.

If it’s high

A level above your lab's range means your body has made more IgE to almond. In general, higher levels make a reaction to almond more likely, but the link is not exact. Some people with high levels eat almonds with no problem, and some people with low or even undetectable levels do react. Your clinician reads the number together with your symptoms.

Common causes

  • Sensitization without symptoms, where you make the antibody but eat almonds with no problem
  • Cross-reacting IgE from other tree nuts or peanut, whose proteins look similar to almond's
  • Pollen allergy, since some nut proteins resemble pollen proteins
  • A true almond allergy
  • A very high total IgE (above about 2,500 kU/L), which can cause a false-positive reading

What can help

  • Talk with an allergist about how this result fits your history of eating almonds
  • Keep notes on any symptoms after almonds or foods that contain them, including how soon they began
  • Ask whether a skin test or a supervised food challenge would help clarify your result
  • If you have been told to avoid almonds, follow the plan your clinician gave you and ask about reading food labels

Usual ranges

What labs print as the reference range, by who was tested. Ranges differ a little between labs, so the range on your own report is the one your result is judged against.

For adults: 0–0.09 kU/L. Source: Mayo Clinic Laboratories, ARUP Laboratories, U.S. Food and Drug Administration, Journal of Allergy and Clinical Immunology.

ImmunoCAP IgE classes (Mayo Clinic Laboratories wording)

  • Class 0: negativebelow 0.1 kU/L
  • Class 0/1: borderline or equivocal0.1 to under 0.35 kU/L
  • Class 1: equivocal0.35 to under 0.7 kU/L
  • Class 2: positive0.7 to under 3.5 kU/L
  • Class 3: positive3.5 to under 17.5 kU/L
  • Class 4: strongly positive17.5 to under 50 kU/L
  • Class 5: strongly positive50 to under 100 kU/L
  • Class 6: strongly positive100 and above kU/L

What can affect your result

  • Age, and how long almond has been avoided or eaten before the test
  • Other allergies, such as to peanut, other tree nuts or pollen, which can cause cross-reacting IgE
  • A very high total IgE (above about 2,500 kU/L) can cause false-positive results
  • The lab and test brand, because results from different systems are not directly comparable
  • Where a lab draws its cutoff (0.10, 0.35 or 0.70 kU/L)
  • A very high total IgE (above about 2,500 kU/L) can cause false-positive results through nonspecific binding (Mayo Clinic Laboratories).
  • Antihistamines do not affect this blood test the way they affect skin-prick testing (NIAID 2010).
  • Different labs and test brands give different numbers for the same blood sample, so compare results from the same lab and system.

Slow. It usually shifts over months to years, not weeks.

When to talk to a clinician

Call 911 or your local emergency number if, after eating almonds or a food that may contain them, you have trouble breathing, swelling of the lips, tongue or throat, dizziness or fainting, or severe stomach pain with vomiting. Talk with a clinician or allergist about milder symptoms, such as hives or mouth itching, even if this result is in the usual range.

Questions you could ask

  • Could my pollen allergy be part of this result?
  • How often, if at all, should we recheck this?
  • Does this result fit with my history of eating almonds?
  • Would a skin test or a supervised food challenge help clarify what this result means?
  • Should I be checked for reactions to other tree nuts or peanut?
  • My result is in the usual range but I have had symptoms after almonds. What should we do next?

Questions people ask

Does a positive almond IgE mean I am allergic to almonds?

Not by itself. The test shows that your immune system has made IgE to almond, which is called sensitization. An expert panel convened by the NIAID says these blood tests alone cannot confirm a food allergy. In one US study of people with a positive tree nut test, about a third (36%) had a history of reactions to tree nuts. Your clinician looks at the result with your symptoms, and sometimes a supervised food challenge.

My lab's cutoff is different from another lab's. Why?

There is no single universal cutoff. Many labs call under 0.10 kU/L negative. Mayo Clinic Laboratories flags results of 0.70 kU/L and above, ARUP lists 0.34 kU/L or lower as its almond reference interval, and the test maker suggests 0.35 kUA/L. Use the range printed on your own report, and ask your clinician how they read it.

If my result is negative, can I rule out an almond allergy?

Not always. A negative result makes an IgE-mediated allergy less likely, but undetectable levels do sometimes occur in people who react. If you have had symptoms after eating almonds, tell your clinician even when this result is negative.

Show the science and sources

For clinicians and researchers

Quantitative allergen-specific IgE to a whole almond extract (ImmunoCAP f20) by fluoroenzyme immunoassay. The ImmunoCAP Specific IgE system reports up to 100 kUA/L with a limit of quantitation of 0.1 kUA/L, is calibrated to the WHO IgE reference (IRP 75/502 or 3rd IS 11/234), and its maker recommends a 0.35 kUA/L cutoff while telling each lab to set its own range (FDA review K173726). Labs differ: Mayo Clinic Laboratories grades results in classes 0 to 6 and flags class 2 and above (0.70 kU/L or more), while ARUP lists 0.34 kU/L or lower as the almond reference interval. Allergen-specific IgE shows sensitization, not clinical allergy. Higher levels go with a higher probability of reaction, but predictive values vary by population and cannot be carried between assay systems, and undetectable IgE occasionally occurs in IgE-mediated food allergy (NIAID 2010, Guideline 7). NIAID's cross-reactivity table lists about 92% sensitization between tree nuts (12 to 37% clinical reactivity, from reported reactions rather than challenges) and 59 to 86% sensitization between tree nuts and peanut (33 to 34% clinical), with higher sIgE correlations for almond and hazelnut. In one US series of 278 patients with positive tree nut sIgE, 36% had a history of acute reactions to tree nuts. Nonspecific binding can cause false positives when total IgE exceeds about 2,500 kU/L (Mayo).

LOINC 6019-4 (primary), 112187-0. Specimen: serum.

Sources

  1. Almond, IgE, Serum (test ID ALM), Mayo Clinic Laboratories
  2. Allergens, Food, Tree Nuts Profile IgE (ARUP test 3017913), ARUP Laboratories
  3. 510(k) Decision Memorandum K173726: ImmunoCAP Specific IgE (ImmunoCAP Allergen f447, rAra h 6, Peanut), U.S. Food and Drug Administration (2018)
  4. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel, Journal of Allergy and Clinical Immunology (2010)

AI-verified against cited sources. Awaiting expert review. Last reviewed 2026-10-03. How we build and check these pages.

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