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Co\u2010reactivity to more than one nut is frequent, and co\u2010sensitization in the absence of clinical data is often obtained. Confirmatory oral food challenges (OFCs) are inconsistently performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the utility of the basophil activation test (BAT) in diagnosing peanut and tree nut allergies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Markers Of Nut Allergy Study (MONAS) prospectively enrolled patients aged 0.5\u201317\u00a0years with confirmed peanut and\/or tree nut (almond, cashew, hazelnut, pistachio, walnut) allergy or sensitization from Canadian (n\u00a0=\u00a0150) and Austrian (n\u00a0=\u00a050) tertiary pediatric centers. BAT using %CD63<jats:sup>+<\/jats:sup> basophils (SSClow\/CCR3pos) as outcome was performed with whole blood samples stimulated with allergen extracts of each nut (0.001\u20101000\u00a0ng\/mL protein). BAT results were assessed against confirmed allergic status in a blinded fashion to develop a generalizable statistical model for comparison to extract and marker allergen\u2010specific IgE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A mixed effect model integrating BAT results for 10 and 100\u00a0ng\/mL of peanut and individual tree nut extracts was optimal. The area under the ROC curve (AUROC) was 0.98 for peanut, 0.97 for cashew, 0.92 for hazelnut, 0.95 for pistachio, and 0.97 for walnut. The BAT outperformed sIgE testing for peanut or hazelnut and was comparable for walnut (AUROC 0.95, 0.94, 0.92) in a sub\u2010analysis in sensitized patients undergoing OFC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Basophil activation test can predict allergic clinical status to peanut and tree nuts in multi\u2010nut\u2010sensitized children and may reduce the need for high\u2010risk OFCs in patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/all.14695","type":"journal-article","created":{"date-parts":[[2020,12,10]],"date-time":"2020-12-10T22:14:04Z","timestamp":1607638444000},"page":"1800-1812","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":68,"title":["Basophil activation test shows high accuracy in the diagnosis of peanut and tree nut allergy: The Markers of Nut Allergy 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