In recent decades, significant progress has been made in understanding allergic reactions to foods. The predictive value of skin testing to foods is much better understood now than in the 1970s, and at least one of the in vitro diagnostic techniques may emerge as an additional aid to management (CAP-FEIA, vide infra). The double-blind, placebo-controlled food challenge (DBPCFC) continues to be the only tool able to prove definitively the presence of food allergy (short of anaphylaxis); however, there remains a place for open food challenges. With the simple tools of skin tests and challenges, typical IgE-mediated food allergy can be fairly simply characterized. Unusual complaints related to foods may also be investigated by modification of these techniques. In this article, we provide a practical approach to the use of skin tests and challenges for diagnosis of food allergy. Use of these techniques should minimize patient risk both from diagnostic procedures and from inappropriately restrictive diets.