Tree Nut Allergy

Tree nut allergy is a growing concern among the food allergic population as its frequency is increasing, and tree nut allergies can be severe, even life threatening. It is estimated that 1%-2% of the United States population have tree nut allergies, peanut allergy, or both. In general, tree nut allergy has been considered a lifelong allergy. However, a recent article in The Journal of Allergy & Clinical Immunology suggests that approximately 9% of children with an allergy to tree nuts will outgrow their allergy, including children who have previously experienced a severe allergic reaction.

Tree nuts include cashews, almonds, walnuts, hazelnuts, macadamia nuts, pecans, pistachios, brazil nut, beechnuts, chestnuts, filbert, and hickory nuts. Pine nuts are edible seeds of pine trees and are not, strictly speaking, tree nuts. However, because of their high allergenic potential, they are included in this discussion. Interestingly, tree nuts are not related to peanuts. Therefore, some people who have peanut allergies can eat tree nuts, and those who have tree nut allergies can sometimes eat peanuts. However, it is important to note that some allergic individuals may be allergic to both peanut and tree nuts. In addition, you can be allergic to some, but not all tree nuts. Almonds allergy seem to cause the least problems of all common tree nut allergies.

Individuals with almond allergy, walnut allergy, hazelnut allergy, Brazil nut allergy, pecan allergy, or macadamia nut allergy are at high risk of a severe allergic reaction upon ingestion or contact with these tree nuts. Such individuals need to constantly be on guard when eating in restaurants where these tree nuts may be cooked in the food. They must not be embarrassed to ask pointed and probing questions to the chef directly. And those who know that they have tree nut allergy should always have an Epipen or other self-injectable epinephrine available.

How to Read a Label for a Tree Nut-free Diet

People with Tree nut allergies should be sure to avoid foods that contain any of the following ingredients:

almonds
brazil nuts
cashews
chestnuts
filberts
hazelnuts
gianduja (a creamy mixture of chocolate and chopped toasted nuts found in premium or imported chocolate)
hickory nuts
macadamia nuts
marzipan/almond paste
nougat
Nu-Nuts® artificial nuts
nut butters, i.e. cashew butter, almond butter
nut oil
nut paste, i.e. almond paste
pecans
pine nuts (pignolia, pinion)
pistachios
walnuts

Helpful Facts About Tree Nuts

Nu-Nuts® artificial nuts are peanuts that have been de-flavored and re-flavored with a nut like pecan or walnut.
Filberts are hazelnuts.
Avoid natural extracts such as pure almond extract, and natural wintergreen extract (for the filbert/hazelnut allergic).
Use imitation or artificially flavored extracts.
Ethnic foods, commercially prepared baked goods, and candy can be cross-contaminated with nuts since nuts are frequently used in these types of foods.
Tree nuts are being added to an increasing variety of foods such as barbecue sauces, cereals, crackers, and ice creams.

Tree nuts may belong to different food families which are unrelated to each other.
Walnut: walnut, pecan
Mango: pistachio, cashew
Legythis: brazil nut
Beech: beech nut, chestnut
Birch: hazelnut, filbert, hickory nut
Plum: almond
Macadamia

What May Contain Tree Nut?

Chocolate
Candies
Cookies
Desserts
Sweets
Almond paste
Donuts
Sundaes
Cereal
Milkshakes
Granola bars
Trail mixes
Pesto sauce
European chocolates
Muesli
Suntan lotion, shampoo, nut shells, bath oils
Popcorn and specialty cheese spreads
Gianduja (chocolate and chopped toasted nuts)
Specialty coffees, liqueurs
Small animal food e.g., hamster, gerbil

What Contains Walnut or Pecan?

Pecan pie, walnut containing muffins
Crosse & Blackwell Worcestershire sauce
AIM herbal fiber blend, pesto sauce, pralines, walnut oil, “Turtles” chocolates

What Contains Hazelnut/Filbert?

Nutella, nougat, Toblerone chocolate bars, hazelnut liqueur, Frangelico liqueur, hazelnut coffee

What Contains Pistachio/Cashew?

Cashew butter, pistachio ice cream, chicken with cashews

What Contains Almonds?

Marzipan, almond mocha, almond paste, almond guy ding, trout almandine, pure almond extract (artificial is okay), amaretto

What About Seeds, Tropical Oils, Exotic Nuts?

Foods such as water chestnut, coconut, and nutmeg do not need to be avoided by nut allergic people, unless they are also allergic to these foods. Palm oil and tropical oils do not need to be avoided. Seeds, e.g., sesame, sunflower, poppy, mustard, safflower, canola, do not need to be avoided unless you are allergic to these as well.

Are Nut Oils Safe?

Most tree nut oils probably contain enough allergenic protein to cause allergic reactions. These are cold pressed (unprocessed, extruded or expelled) oils and are not safe for nut allergic people.

The Online Allergist