- What Should I Do if I’m Allergic to Nuts?
- Tree Nut Allergy Diet Guide
- Tree Nut Allergy
- How to Read a Label for Tree Nuts
- TREE NUTS ARE SOMETIMES FOUND IN
- Cross Reactivity: Do You Need to Avoid Other Foods?
- Nutrition for a Nut-Free Diet
- Tree Nut Substitutions
- Nut-Free Recipes
- Tree nuts and peanuts
- Tree Nut | Food Allergy Research & Education
- Tree Nut Allergies: Understanding Tree Nut Allergy Symptoms & Treatment
- Tree Nut Allergy Symptoms and Diagnosis
- Tree Nut Allergy Management
- Treatment for Tree Nut Allergy Reactions
- Tree Nut Allergy Suffers Should Avoid Food Containing These Ingredients:
- Unexpected Sources of Tree Nut Products
- Understanding Tree Nut Allergies
What Should I Do if I’m Allergic to Nuts?
- Nut Allergy Basics
- Peanut Allergies
- Food Substitutes
- Food Labels
Even a little bit that you swallow or inhale could cause an allergic reaction. You know to avoid the obvious foods, such as almond butter, cookies with walnuts baked in, or oatmeal studded with pistachios.
But other trigger foods, including sauces and gravies, are more surprising.
You need to know what to look for, so you can check before you buy or use a product.
Peanuts and tree nuts aren’t the same. But if you’re allergic to one, you may also need to avoid the other. Ask your doctor to be sure.
Tree nuts include:
- Brazil nuts
- Hickory nuts
- Macadamia nuts
You may find peanuts or tree nuts in things these:
- Baked goods. Cookies, candy, pastries, pie crusts, and others
- Candy. Chocolate candy especially; also nougat and marzipan
- Other sweets. Ice cream, frozen desserts, puddings, and hot chocolate
- Cereals and granola
- Trail mix
- Chili and soups. Peanuts or peanut butter are sometimes used as thickeners.
- Grain breads
- High-energy bars
- International foods. Nuts are common ingredients in African and Asian cooking (especially Thai and Indian); also in Mexican and Mediterranean foods.
- Mortadella. This Italian ham may include pistachios.
- Veggie burgers
- Sauces. These may include barbeque sauce, hot sauce, pesto, gravy, mole sauce, glazes, or marinades.
- Salads and salad dressing
Nix them when you cook, and look for them on food labels:
- Nut butters. Almond, cashew, peanut, and others
- Nut pastes. Includes products marzipan, almond paste, and nougat
- Nut oils. Includes cold-pressed or expressed peanut oil, and others
- Hydrolyzed plant or vegetable protein. These can have peanuts in them.
- Peanut flour
- Nut extracts, almond extract
1. Ask your server. Foods that don't contain peanuts or tree nuts can get contaminated if they’re made in the same place or with the same equipment. It can also happen in restaurants that use lots of ingredients, and even in ice cream parlors if scoops or other equipment are shared.
2. Check the label each time you buy a product. Food makers sometimes change the recipe.
3. Look outside the kitchen. Nuts can also be in lotions, shampoos, and pet food. Check labels before you buy or use them.
Carry two epinephrine auto-injectors ( Auvi-Q, EpiPen, Symjepi) at all times, and know how to use them. For some people, an allergic reaction to nuts can become life-threatening, so always be prepared.
Children with a severe peanut allergy may benefit from using the drug Palforzia, which can help lessen symtoms if exposure occurs. If you have an allergic reaction, call 911 right away. If you have epinephrine, use it and repeat after 5 to 15 minutes if your symptoms haven’t improved.
You’ll still need medical care right after you give yourself the shots — even if your symptoms seem to stop — in order to prevent a delayed reaction.
Food Allergy & Anaphylaxis Network: “Peanuts,” Tree Nuts.”
Food Allergy Initiative: “Tree Nut allergy.”
KidsHealth: “Nut and Peanut Allergy.”
© 2020 WebMD, LLC. All rights reserved. Food Substitutes
Tree Nut Allergy Diet Guide
GARO/PHANIE / Getty Images
Tree nuts are a common food allergy: in the United States, about 0.5% of the population—or about one in every 200 people—is allergic to tree nuts. Tree nuts frequently cause strong allergic reactions and may cause anaphylaxis, which is a potentially life-threatening allergic reaction.
It's possible to be allergic to just one type of tree nut, but many people are allergic to multiple different types of tree nuts. In addition, it's common for food manufacturers to process different types of tree nuts on the same equipment, raising risks for people who are allergic. Therefore, if you have a tree nut allergy, your doctor may warn you to avoid most or all tree nuts.
The most common tree nuts include macadamia nuts, brazil nuts, cashews, almonds, walnuts, pecans, pistachios, chestnuts, hazelnuts (filberts), and pine nuts (pignoli or pinon). Less common tree nuts include beechnuts, butternuts, chinquapins, gingko, hickory nuts, lychee nuts, pili nuts, and shea nuts.
The majority of individuals with a tree nut allergy will have it for their lifetime. However, recent research indicates about 9% of children with tree nut allergy will outgrow that allergy. For this reason, physicians recommend that children with allergies to tree nuts be reevaluated periodically by a board certified allergist to see if they're in the group that outgrows the allergy.
Children who are allergic to multiple types of tree nuts (more than one or two) are less ly to outgrow their allergy than children who are allergic to just one type of tree nut.
People can be allergic to one type of tree nut, to some tree nuts, or to many tree nuts but not to other types of tree nuts.
That's because some tree nuts contain similar proteins—for example, almonds and hazelnuts contain similar proteins, as do walnuts and pecans, and pistachios and cashews.
Because of these protein similarities, it is common for an individual to have an allergy to both nuts. For instance, if you are allergic to cashew, you have a greater risk of being allergic to pistachios, as well.
However, most people with tree nut allergy are not allergic to all tree nuts. The decision to avoid all tree nuts when there is an allergy to one or more tree nuts is a personal one and one you should discuss with your doctor. In food production, the risk of cross-contact with multiple tree nuts is higher, which has led many health professionals to recommend avoidance of all tree nuts.
Peanuts are legumes and are biologically unrelated to tree nuts. Tree nut allergy and peanut allergy are two different types of allergies. Still, while people allergic to tree nuts are not necessarily allergic to peanuts, it's also possible be allergic to both.
You should be aware that tree nuts and peanuts are often found together in processed foods and nut mixtures. If you are diagnosed with a tree nut allergy, your allergist will advise you whether to avoid peanuts, as well.
Symptoms associated with a tree nut allergy include:
- tingling of the lips
- itching of the mouth, ears, and eyes
- oral allergy syndrome
- contact dermatitis
- throat tightening
- urticaria (hives)
- asthma (in asthmatics)
- abdominal pain
People with tree nut allergy should carry a source of epinephrine at all times in case they have a dangerous allergic reaction.
Tree nuts are one of the most common food allergies, and as such, the U.S. Food and Drug Administration requires manufacturers selling foods in America to label foods containing tree nuts. The Food Allergy Labeling and Consumer Protection Act (FALCPA) requires that manufacturers label which tree nut is in a given product.
Manufacturers are not required to mention the presence of tree nuts on manufacturing lines. Many do, however, due to consumer pressure. Because of the possibility of anaphylaxis, people with tree nut allergies should avoid products that mention the possibility of tree nut cross-contamination on labels.
Remember to always read your food packaging and ingredient labels, since ingredients and manufacturing practices can change at any time.
Food that always or almost always contains tree nuts include:
- Nutella (made from hazelnuts)
- marzipan (almond paste)
- pesto (unless specially prepared without pine nuts)
- nut liqueurs (Frangelico, Amaretto, and Nocello)
- turrón (a candy typically made with almonds)
- gianduja (a creamy mixture of chocolate and chopped almonds and hazelnuts; other nuts can be used)
- nut flours (almond flour is the most common)
Foods that may contain tree nuts include:
- granola bars
- trail mix
- caponata (a dish made from eggplant that often includes pine nuts)
- ice cream
- candy bars
- baked goods
- energy bars
- flavored coffee
- frozen desserts
- barbecue sauces
- mortadella (lunchmeat)
- nut meal
- natural extracts: almond and wintergreen (filbert/hazelnut allergy)
As with many common allergens, tree nuts are sometimes found in unly foods, so be sure to read labels on all packaged foods before buying or eating them.
Many people consider coconut a fruit. When the FDA mandated that coconut be considered a tree nut for labeling purposes, it caused some confusion.
In fact, coconut allergy is uncommon, and studies have shown that people with tree nut allergy are at no greater risk of being allergic to coconuts. Many tree nut allergic individuals can tolerate coconut in milk and yogurt form. Talk to your allergist about including coconut if it is not currently part of your diet.
Tree nuts aren't as common in restaurant cuisines as other allergens. However, the risk of a dangerous reaction makes eating out tricky.
Cuisines that may use nuts include:
- Greek (some dishes use walnuts)
- Chinese (cashews are included in many stir-fry dishes)
- Mediterranean (almonds are common)
- Italian (pesto is made with pine nuts)
In addition, high-end restaurants may use tree nut oils to make marinades and salad dressings. Japanese and Latin American cuisines are among the safer choices, but you should always err on the side of caution.
Tree nut allergy is among the top four allergens causing the most severe allergic reactions (the other three are peanut, fish, and shellfish).
If you also have asthma, you have a higher risk for a severe allergic reaction. For this reason, it's essential that anyone with a tree nut allergy learn the symptoms of anaphylactic shock and carry injectable epinephrine at all times.
Managing your tree nut allergy depends on strict avoidance of the tree nuts that cause your allergic symptoms.
As the parent of a young child with a tree nut allergy, you'll need to involve a wide variety of adults in your child's life in order to keep your child safe, including caregivers, school teachers and administrators, and the parents of close friends.
There are some places where it may be difficult to avoid tree nuts. These include parties (where bowls of mixed nuts may be served) and bars. For this reason, it is important to teach children how to talk about their food allergy.
Anyone with a tree nut allergy (or caring for a child with a tree nut allergy) should be thoroughly briefed on reading labels, the symptoms of severe food allergies, and treating food allergies.
Tree Nut Allergy
Tree nut allergy is the second most common allergy in infants and young children. Approximately 0.4- 0.5% of American children have a tree nut allergy. Tree nuts are a common allergen reported to cause fatal and near-fatal allergic reactions.
Tree nut allergy is usually life-long once acquired. Approximately 9% of children allergic to tree nuts may outgrow their allergy.
Children with a tree nut allergy must avoid that tree nut and all products containing that type of tree nut.
Children with a tree nut allergy also must avoid anything containing traces of ingredients containing that tree nut.
There is a potential of tree nut products having cross-contact other tree nuts and with peanuts. For this reason, your child's doctor may advise you to avoid all tree nuts and peanuts.
How to Read a Label for Tree Nuts
Always read the entire ingredient label to look for the names of the tree nut(s) you need to avoid. Tree nut ingredients may be within the list of the ingredients.
Or tree nuts could be listed in a “Contains” statement beneath the list of ingredients. Examples are “Contains Walnut” or “Contains Almond”.
This is required by the federal Food Allergen Labeling and Consumer Protection Act (FALCPA). Learn more about the U.S. food allergen labeling law.
FALCPA requires that all packaged foods regulated by the FDA must list the common names of tree nuts clearly on the ingredient label if it contains tree nuts.
Advisory statements such as “may contain hazelnuts” or “made in a facility with tree nuts” are voluntary. Advisory statements are not required by any federal labeling law.
Discuss with your doctor if you may eat products with these labels or if you should avoid them.
Did you know that marzipan, mortadella and mandelonas all contain tree nuts? The FDA food allergen label law requires foods to state if they contain a top 8 allergen such as tree nuts.
But, there are many foods and products that are not covered by the law, so it is still important to know how to read a label for tree nut ingredients. Products exempt from plain English labeling rules: (1) Foods that are not regulated by the FDA.
(2) Cosmetics and personal care items. (3) Prescription and over-the-counter medications. (4) Toys, crafts and pet food.
The following ingredients found on a label indicate the presence of tree nuts. All labels should be read carefully before consuming a product, even if it has been used safely in the past. AlmondBeechnutBrazil nutBush nutButternutCashewChestnutCoconut*FilbertGinko nutHazelnutHickory nutLichee nutMacadamia nutNangai nutPecanPine nutPistachioShea nut
AlmondAlmond pasteAnacardium nutsAnacardium occidentale (Anacardiaceae) [botanical name, Cashew]Artificial nutsBeech nutBrazil nutBertholletia excelsa (Lecythidaceae) [botanical name, Brazil nut]Bush nutButternutButyrospermum Parkii [botanical name, Shea nut]Canarium ovatum Engl. in A. DC. (Burseraceae) [botanical name, Pili nut]CaponataCarya illinoensis (Juglandaceae) [botanical name, Pecan]Carya spp. (Juglandaceae) [botanical name, Hickory nut]CashewCastanea pumila (Fagaceae) [botanical name, Chinquapin]Castanea spp. (Fagaceae) [botanical name, Chestnut (Chinese, American, European, Seguin)]Chestnut (Chinese, American, European, Seguin)ChinquapinCoconut*Cocos nucifera L. (Arecaceae (alt. Palmae)) [botanical name, Coconut]Corylus spp. (Betulaceae) [botanical name, Filbert/hazelnut]FilbertFagus spp. (Fagaceae) [botanical name, beech nut]GiandujaGinko nutGinkgo biloba L. (Ginkgoaceae) [botanical name, Ginko nut]HazelnutHeartnutHickory nutIndian nutJuglans cinerea (Juglandaceae) [botanical name, Butternut]Juglans spp. (Juglandaceae) [botanical name, Walnut, Butternut, Heartnut]Karite (shea nut)Lichee nutLitchi chinensis Sonn. Sapindaceae [botanical name, Lichee nut]Lychee nutMacadamia nutMacadamia spp. (Proteaceae) [botanical name, Macadamia nut/Bush nut]MandelonasMarzipanMashuga nutsNangai nutsNatural nut extract (for example, almond extract)NougatNu-Nuts®Nut butters (e.g., Almond butter, Hazelnut butter, Brazil nut butter, Macadamia nut butter, Pistachio nut butter, Shea nut butter, Karike butter, as well as other nut butters)Nut mealNutella ®NutmeatNut oil (e.g., Walnut oil as well as other nut oils)Nut pasteNut piecesPecanPigñoliaPili nutPine nutPine nut (Indian, piñon, pinyon, pigndi, pigñolia, pignon nuts)Pinon nutPiñon or Piñon nutPinus spp. (Pineaceae) [botanical name, Pine nut/piñon nut]PistachioPistacia vera L. (Anacardiaceae) [botanical name, Pistachio]PralinesPrunus dulcis (Rosaceae) [bontanical name, almond]Shea nutSheanutVitellaria paradoxa C.F. Gaertn. (Sapotaceae) [botanical name, Shea nut]
Walnut (English, Persian, Black, Japanese, California)
TREE NUTS ARE SOMETIMES FOUND IN
Artificial flavoringBaked goodsMortadellaNatural flavoringNougat
However, if the product is an FDA regulated food, the common tree nut name must appear on the label.
The FDA lists coconut as a tree nut. In fact, coconut is a seed of a drupaceous fruit. Most people allergic to tree nuts can safely eat coconut. Coconut allergy is reasonably rare. If you are allergic to tree nuts, talk to your allergist before adding coconut to or eliminating coconut from your diet.
Cross Reactivity: Do You Need to Avoid Other Foods?
Cross-reactivity occurs when the proteins in one food are similar to the proteins in another. When that happens, the body's immune system sees them as the same.
Tree nuts are in a different plant family than peanuts. Peanuts are legumes and are not related to tree nuts (almonds, walnuts, cashews, etc.). However, about 35% of peanut-allergic toddlers in the U.S.
have or will develop a tree nut allergy. Doctors often recommend that young children avoid tree nuts if they are allergic to peanuts.
This is because it is fairly common to be “co-allergic” to tree nuts if a child is allergic to peanuts.
There is a high degree of cross-reactivity between cashew and pistachio and between walnut and pecan. Most people who are allergic to one tree nut are not allergic to all tree nuts. But some doctors will advise their patients to avoid all tree nuts if allergic to one or more tree nuts. Check with your doctor to find out if you need to avoid all tree nuts.
Nutrition for a Nut-Free Diet
Tree nuts are a good source of protein, vitamins and minerals in a child's diet. However, if your child needs to avoid nuts of any type, they should not be at nutritional risk since there are many other sources of protein to eat instead.
|NUTRIENTS LOSTWHEN AVOIDING TREE NUTS||SUGGESTED ALTERNATE SOURCES(if not allergic)|
|Protein, Vitamins, Minerals||Increase other protein foods such as meat, legumes, fish, poultry, eggs, dairy(if safe for your child);fruit, vegetables, and enriched grains|
Tree Nut Substitutions
It is very easy to replace nuts in a recipe. There are many seeds and seed products available including sunflower butter and pumpkin seed butter. Roasted chickpeas can replace nut snacks. Pretzels can substitute for pecans in pecan pie.
Learn more about NUT SUBSTITUTES.
Over 1100 nut-free recipes are available in KFA's Safe Eats™ Recipes. Search for Nut-Free Recipes
|Chocolate Mousse||Berry Berry Ice Cream Pie||Pumpkin Pudding|
Medical review February 2015.
Tree nuts and peanuts
There’s often confusion between peanuts and tree nuts. Peanuts are legumes, not nuts; still, between 25 and 40 percent of individuals who are allergic to peanuts also react to at least one tree nut, according to studies.
Allergists generally advise people who are allergic to tree nuts also to avoid peanuts because of the risk of cross-contact and cross-contamination between tree nuts and peanuts in food processing facilities. If you or your child is allergic to either peanuts or tree nuts, ask your allergist whether you should avoid both products.
The prevalence of these allergies in children appears to be growing, according to a 2010 study that compared data from telephone surveys of 5,300 U.S. households in 1997, 2002 and 2008. In the 2008 survey, 2.
1 percent of respondents reported having a child with an allergy to peanuts, tree nuts or both. In the 2002 survey, 1.2 percent of subjects said they had a child with one or both of these allergies; five years earlier, in 1997, only 0.
6 percent of respondents reported having a child with one or both of these allergies.
Allergies to tree nuts and peanuts are among the most common causes of anaphylaxis in the United States.
An allergist will advise patients with these allergies to carry an auto-injector containing epinephrine (adrenaline), which is the only treatment for anaphylactic shock, and will teach the patient how to use it.
If a child has the allergy, teachers and caregivers should be made aware of his or her condition as well.
People with tree nut allergies often wonder if they must also avoid coconut and nutmeg.
Coconut is not a botanical nut; it is classified as a fruit, even though the Food and Drug Administration recognizes coconut as a tree nut. While allergic reactions to coconut have been documented, most people who are allergic to tree nuts can safely eat coconut. If you are allergic to tree nuts, talk to your allergist before adding coconut to your diet.
Nutmeg is a spice that is derived from seeds, not nuts. It may be safely consumed by people with a tree nut allergy.
Use the Find an Allergist tool to find expert care for your tree nut allergy.
Tree Nut | Food Allergy Research & Education
To prevent a reaction, it is very important that you avoid all tree nuts and tree nut products.
If you’re allergic to one type of tree nut, you have a higher chance of being allergic to other types. For this reason, your doctor may recommend you avoid all nuts. You may also be advised to avoid peanuts because of the higher lihood of cross-contact with tree nuts during manufacturing and processing.
Tree nuts are one of the eight major allergens that must be listed on packaged foods sold in the U.S., as required by federal law.
Avoid foods that contain tree nuts or any of these ingredients:
- Artificial nuts
- Black walnut hull extract (flavoring)
- Brazil nut
- Chinquapin nut
- Gianduja (a chocolate-nut mixture)
- Ginkgo nut
- Hickory nut
- Litchi/lichee/lychee nut
- Macadamia nut
- Marzipan/almond paste
- Nangai nut
- Natural nut extract (e.g., almond, walnut—although artificial extracts are generally safe)
- Nut butters (e.g., cashew butter)
- Nut distillates/alcoholic extracts
- Nut meal
- Nut meat
- Nut milk (e.g., almond milk, cashew milk)
- Nut oils (e.g., walnut oil, almond oil)
- Nut paste (e.g., almond paste)
- Nut pieces
- Pili nut
- Pine nut (also referred to as Indian, pignoli, pigñolia, pignon, piñon and pinyon nut)
- Shea nut
- Walnut hull extract (flavoring)
Some Unexpected Sources of Tree Nuts
Allergens are not always present in these food and products, but you can’t be too careful. Remember to read food labels and ask questions about ingredients before eating a food that you have not prepared yourself.
Tree nut proteins can be found in some surprising places, such as cereals, crackers, cookies, candy, chocolates, energy bars, flavored coffee, frozen desserts, marinades, barbeque sauces and some cold cuts, such as mortadella.
Ice cream parlors, bakeries and certain restaurants (e.g., Chinese, African, Indian, Thai and Vietnamese) are considered high risk for people with tree nut allergy. Even if you order a tree nut-free dish, there is high risk of cross-contact.
Tree nut oils, such as walnut and almond, are sometimes used in lotions, hair care products and soaps.
Some alcoholic beverages may contain nut flavoring, so consider avoiding these as well. Because these beverages are not federally regulated, you may need to call the manufacturer to determine the safety of ingredients such as natural flavoring.
Argan oil is derived from the nut of the argan tree and has rarely been reported to cause allergic reactions. While it is not a common food in the U.S., you will often find it in Morocco.
People with cashew allergy may be at higher risk for allergy to pink peppercorn (known as Brazilian Pepper, Rose Pepper, Christmasberry and others). This dried berry (Schinus, related to cashew) is used as a spice but is different from standard black pepper and fruits with “pepper” in their name (e.g., bell peppers, red peppers or chili peppers).
There is no evidence that coconut oil or shea nut oil and butter are allergenic. Coconut, the seed of a drupaceous fruit, has typically not been restricted in the diets of people with a tree nut allergy.
However, in October 2006, the FDA began identifying coconut as a tree nut.
Medical literature documents a small number of allergic reactions to coconut; most occurred in people who were not allergic to tree nuts.
Tree Nut Allergies: Understanding Tree Nut Allergy Symptoms & Treatment
Tree nut allergy ranks as one of the most common food allergies for children and adults. An allergy to tree nuts is often life-long with only 9% of children outgrowing it. Siblings of children with a tree nut allergy may be at a higher risk food allergies and should be tested if an adverse reaction to foods is noticed.
What are tree nuts? Tree nuts include almonds, cashews, Brazil nuts, hazelnuts, pistachios, and walnuts.
Tree nuts differ from peanuts (a legume), but those with a tree nut allergy may have a higher chance of being allergic to other similar foods. Experts suggest tree nut allergy sufferers should avoid all nuts due to the lihood of cross-contamination during processing or manufacturing.
If individuals with a tree nut allergy come in contact with the allergen, they could experience a severe, potentially fatal allergic reaction known as anaphylaxis.
Those with a history of severe food allergies should carry an epinephrine auto-injector with them at all times.
Caregivers and school personnel should be aware of a child’s allergy, be familiar with the signs and symptoms of food allergies and know how to properly deliver an epinephrine injection if needed.
Tree Nut Allergy Symptoms and Diagnosis
A tree nut allergy may cause a person to exhibit the following signs and symptoms within two hours of consuming tree nut products:
- Nausea and vomiting
- Abdominal pain and cramps
- Difficulty swallowing, throat tightness
- Nasal congestion and a runny nose
- Itching or swelling of the lips, tongue, throat, skin, eyelids, or other area
- Shortness of breath, coughing or chest tightness
- Anaphylaxis (a potentially life-threatening reaction)
If you or a child is experiencing an anaphylactic reaction, call 911 immediately.
If you or a child is experiencing non-life-threatening symptoms, schedule an appointment with an allergist as soon as possible for testing.
During your appointment, the allergist will review your medical history and family history of allergies.
They’ll ask detailed questions about the foods you eat, symptoms you experience, how long the symptoms last, and what helps make the symptoms better.
Skin-prick tests and/or blood tests may be used to discover if antibodies are present for a tree nut allergy. The skin-prick test is applied on small spot on your upper back or forearm with a small toothpick- stylet.
Concentrated tree nut extract is introduced into the uppermost layer of your skin. If small, raised hive develops then you ly have a tree nut allergy. Skin test results are available within 20 minutes of applying the test.
Blood tests involve taking a small sample of your blood and test it for immunoglobulin E (IgE) antibodies. IgE antibodies are soldiers that hunt for specific food allergens.
When IgE encounters the culprit food protein, it triggers an immediate release of chemicals responsible for the allergic reaction and associated symptoms.
Blood tests results usually take about one week to return after being drawn.
Tree Nut Allergy Management
Similar to many other food allergies, the best way to treat and manage tree nut allergy is by avoiding contact with or consuming tree nut products.
While some individuals diagnosed with a tree nut allergy may tolerate other nuts, allergists caution patients to avoid all nuts. They can often be hidden in Asian dishes, salads, used as an ice cream topping or included in baked goods, sauces, and desserts.
If you or a child has a serious allergy, read all labels carefully and ask before ordering dishes at restaurants. If you are unsure, avoidance is the best option.
Treatment for Tree Nut Allergy Reactions
Allergies to food are some of the most common and dangerous. Patients are advised to carry an epinephrine auto-injector with them at all times for immediate treatment.
If serious reactions occur, call 911 immediately. Caregivers and teachers of children with a tree nut allergy should have access to an epinephrine auto-injector and be trained on administering epinephrine.
Tree Nut Allergy Suffers Should Avoid Food Containing These Ingredients:
- Artificial nuts
- Brazil nut
- Hickory nut
- Macadamia nut
- Nut extract (artificial and natural almond or walnut extract)
- Nut butter (almond or cashew butter)
- Nut milk (almond or cashew milk)
- Nut meal
- Nut pieces
- Pine nut
Unexpected Sources of Tree Nut Products
Unexpected products may contain tree nuts. Check all labels before consuming products including:
- Alcoholic beverages (may contain nut flavoring)
- Meat substitutes – vegetarian or vegan foods may contain meat substitutes containing tree nuts
- Nut oils (almond and walnut oil)
- Sauces including pesto, glazes, and marinades
- Cereals, cookies, and crackers
- Candy and chocolates
- Energy bars
- Flavored coffee
- Lotions, hair care products, and soaps
Are you experiencing allergic reactions after eating foods containing tree nuts? Contact your allergy specialist and schedule a test to confirm if you have a tree nut allergy or to discover if you’re experiencing an allergic reaction to a different source.
Understanding Tree Nut Allergies
Walnut allergy is the most common tree nut allergy in the US.
Greenlin / Moment / Getty Images
Tree nuts are an important food source worldwide as well as one of the most common food allergies. Approximately one in 20 Americans is allergic to tree nuts. There are a number of different types of tree nuts, and the allergic cross-reactivity between them is high.
However, just because you are allergic to one tree nut does not mean you won't be able to eat another tree nut. The risk varies from person to person.
Symptoms of tree nut allergies are the same as other food allergies, although they tend to be more severe. If allergic to tree nuts, your doctor will advise you to avoid all tree nuts as part of your treatment plan.
Should you eat a tree nut and have an allergic reaction, you may need to use injectable epinephrine and/or an oral antihistamine. Un other common food allergies, you are less ly to outgrow a tree nut allergy, especially if you are prone to reactions.
Peanuts are different from tree nuts in that they are actually a legume. However, 30% of people with a peanut allergy will also be allergic to at least one type of tree nut.
The risk of allergy to tree nuts varies by the type. Though you can ultimately be allergic to any type of tree nut, there are four that are known to trigger symptoms more than others.
Pistachios commonly cause food allergy symptoms and are cross-reactive to cashews and mangoes. Hay fever to the pollen from the Parietaria weed found in Europe appears to predispose to pistachio allergy.
Almonds are the most popular tree nut consumed in the United States and the third most common tree nut allergy. Almonds are commonly used when processing food and are ingredients in breakfast cereals, granola bars, and baked goods. Having an almond allergy may predispose you to other tree nut allergies, especially pistachio nuts.
Generally speaking, the popularity of a tree nut translates to the incidence of allergy to that nut within a population.
Cashews are the second most common allergy-causing tree nuts. The oil found in the nutshell of the cashew is known to cause contact dermatitis and is related to the oils found in the leaves of poison oak and in the skin of mangoes.
Cashew allergens are similar to those in pistachios, hazelnuts, walnuts, peanuts, sesame, and buckwheat. If you have a cashew allergy, you may also experience allergic reactions to these other foods.
Walnuts, especially English walnuts, are the most common type of tree nut allergy. If you are allergic to walnut pollen, you may experience symptoms of allergic rhinitis. Pecans and walnuts are closely related, so some people who are allergic to one are also allergic to the other.
Other tree nuts may cause allergic symptoms, but sometimes they aren't “true” allergies. Oral allergy syndrome (OAS) occurs when a certain food allergen is similar to an allergen found in tree or grass pollen. As such, they echo the true allergy but tend to be less severe.
Pecans are a common food in the southern United States, but less common elsewhere in the world. Approximately one in 20 adults in the U.S. will have a reaction to pecans. If you have a pecan allergy, you may have a walnut allergy as well, given how similar allergens in the two nuts are.
If you have a latex allergy or an avocado allergy, you may also have a chestnut allergy given the similarity between the allergens found in latex and these foods. Mugwort pollen, apples, and peaches may give you a reaction as well if you are sensitive to chestnuts.
Allergy to hazelnut is more common in Europe than in the United States. Hazelnut pollen is a common cause of seasonal hay fever. If you have a hazelnut pollen allergy, you are also at risk for a food allergy to the tree nut itself.
Hazelnuts may cause oral allergy syndrome in people with a birch pollen allergy. Symptoms (including itching, swelling, and burning in the mouth and throat) develop within a few minutes and tend to resolve within 30 minutes to an hour.
If you have a birch pollen allergy, you may experience oral allergy symptoms with eating hazelnuts. If you have a hazelnut allergy, you may also be allergic to coconut, cashews, peanuts, and soybeans, given the similarity between the allergens in these foods.
Some tree nuts are less commonly associated with allergy, often because they are not commonly or widely consumed within a population.
Brazil nut allergies are not common, which may be due to their lack of popularity in the U.S. Brazil nut allergies may increase in the future since genetically modified soybeans have proteins similar to those found in Brazil nut allergen. If you are allergic to Brazil nuts, you may also be allergic to walnuts.
Pine nuts are a common food in southern Europe, but less common in other parts of the world. They are actually a seed, not a nut, but allergy to pine nuts is possible.
Macadamia nuts are common in Hawaii and the tropics. There is some cross-reactivity between the allergens in macadamia nuts and hazelnuts.
Coconut allergies are rare and coconuts are only distantly related to other tree nuts. However, some research shows a similarity between coconut allergens and those in almonds and macadamia nuts.