4 year old girl with a PMH of mild atopic dermatitis presents for evaluation of her peanut allergy. The patient was given peanut butter around 1 year of age and immediately complained of an itchy and uncomfortable sensation in her mouth. She then developed hives over her face/neck within 5 minutes. She was treated with diphenhydramine with resolution of symptoms within one hour. She was evaluated by her pediatrician, who ordered blood work that revealed peanut-specific IgE = 0.91 kU/L. The child had a similar reaction 1 month later when accidentally given a granola bar with peanut but has since avoided peanuts and all tree nuts with no accidental ingestions. The peanut allergy has not been evaluated for nearly 3 years.