We present a case of an 8 year-old boy who experienced anaphylaxis to hazelnut extract on skin prick testing using commercial extract. At 5 years of age, after eating a quarter of a teaspoon of Nutella, he developed drooling, difficulty swallowing, sensation of a tight throat, burning mouth, lip angioedema and urticaria and was treated with intramuscular adrenaline after presentation to The Children's Hospital at Westmead emergency department. Skin prick testing performed at this time confirmed sensitisation to hazelnut (5.5mm-commercial hazelnut extract), with no other nut sensitisation. At age 8, he subsequently experienced anaphylaxis (tight throat, hoarse voice, tongue and lip angioedema, perioral rash and abdominal pain) to cookies containing hazelnut chocolate. He had also experienced several less severe generalised allergic reactions after ingesting confectionary foods (ice cream and lollies) which were considered possibly related to hazelnut contamination. Subsequent to his review at age 8, he also experienced anaphylaxis to a homemade oat muffin, unlikely to have been contaminated with hazelnut, with confirmed ssIgE to storage mite of 2kU/L. Otherwise, he has a past history of eczema and asthma which have now both resolved, and seasonal and perennial allergic rhinitis with sensitisation to house dust mites and New South Wales grasses. On clinical review at age 8, repeat skin prick testing using hazelnut commercial extract was undertaken. Within 5 minutes, he developed a sensation of throat swelling, lip angioedema, rhinorrhoea, flushing and a cough. Intramuscular adrenaline was administered with good response. This case highlights the small but real risk of anaphylaxis during allergy skin prick testing even when using commercial extracts and therefore, the requirement for preparedness and readily available resuscitation equipment when undertaking allergy skin prick testing. We will review the literature regarding this risk and any possible cofactors which may contribute.