BACKGROUND: Peanut allergy accounts for 25% of food allergic children, but current testing has a poor positive predictive value (PPV) and low accuracy, with peanut allergy over-diagnoses estimated to be greater than 60% in clinical settings. New methods for peanut allergy diagnosis via Bead-Based Epitope Assay (BBEA) testing with Ara h 2.008 and Ara h 2.019 epitopes have retrospectively shown improved accuracy in peanut allergy diagnosis. OBJECTIVE: Prospectively evaluate BBEA testing for peanut allergy in a real-world racially diverse clinical population with determination of BBEA testing accuracy, PPV, negative predictive value (NPV), sensitivity and specificity. METHODS: Patients from a tertiary food allergy clinic underwent standard testing for peanut allergy, including skin prick testing, specific IgE testing, and evaluation of peanut IgE component (Ara h 1, 2, 3, 6, 8, and 9) testing. BBEA evaluation to the Ara h 2.008 and Ara h 2.019 epitopes was performed on all patients and oral food challenges were offered to patients with indeterminate standard testing. RESULTS: In this real-world population study, BBEA testing has a 96% accuracy, 96% PPV, 94% NPV, 98% sensitivity, and 89.5% specificity. For children under the age of 2 years old and Black children, the accuracy, PPV, NPV, sensitivity, and specificity were 100%.. The NPV was 100% in patients with no peanut ingestion or reaction history. CONCLUSION: The use of BBEA testing has a higher diagnostic accuracy compared to standard food allergy testing and may decrease need for unnecessary oral food challenges in clinical settings.