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Every Little Detail About Living with a Tree Nut Allergy

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If you or a loved one are dealing with a new tree nut allergy diagnosis you may be left with many questions.  

Can I eat peanuts if I have a tree nut allergy?  Is coconut safe to eat with a tree nut allergy?  Can someone with a tree nut allergy have nutmeg? And what’s this I hear about pink peppercorn?

In this article we will discuss lots of common questions that arise with a tree nut allergy diagnosis and how to stay safe.

Remember: this post is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here. Keep in mind food production can change, always check food labels to be sure products are free of your particular food allergen. For further information please see full Disclaimer.

How Common is a Tree Nut Allergy?

About 2% of children have an allergy to tree nuts (1).

How Likely am I to Outgrow a Tree Nut allergy?

Unfortunately, only about 9% of children with a tree nut allergy are able to outgrow this allergy (2).   This is lower than a peanut allergy which is about a 20% chance of being outgrown (3).  Unfortunately, those with a tree nut allergy usually have it for life.

Sadly, if you have an allergy to more than one tree nut (example:  walnut, pecan) the chances of outgrowing the allergy are even lower.

What are the 9 Most Common Food Allergies?

The top 9 food allergies also known as the big 9 allergens in the United States are:

  1. Milk
  2. Egg
  3. Peanut
  4. Soy
  5. Wheat
  6. Tree Nut
  7. Shellfish
  8. Fish
  9. Sesame

I encourage you to click on the links above to learn more about each of these food allergens.

The Top 9 Food Allergens in the U.S. Top 9 Food Allergies. 1. Fish 2. Shellfish 3. Tree Nuts 4. Peanuts 5. Milk 6. Wheat 7. Egg 8. Soy 9. Sesame

It is important to note that you can be allergic to many other foods besides these top nine.

What are Symptoms of a Tree Nut Allergy?

Tree nut  allergy symptoms can vary from person to person but reactions are often serious.  Be sure to review signs and symptoms of severe allergic reactions such as anaphylaxis.  

Here are some possible symptoms of a tree nut allergy:

  • Hives
  • Swelling of lips, tongue, throat, face
  • Dizziness
  • Anaphylaxis
  • Itching or swelling of the lips, tongue, or throat
  • Diarrhea
  • Weak pulse
  • Repetitive coughing
  • Difficulty swallowing
  • Abdominal pain and cramps
  • A drop in blood pressure
  • Difficulty breathing
  • Nausea and vomiting
  • Runny nose
  • Congestion (stuffy nose)
  • Digestive problems
  • Coughing
  • Loss of consciousness

An allergic reaction to tree nuts can occur minutes to hours after ingestion.  

As mentioned, anaphylaxis is not uncommon with a tree nut allergy.  If a severe reaction occurs, epinephrine is required. 

A Food Allergy and Anaphylaxis  Emergency Care Plan is a great tool that should be used if you or someone you know has a food allergy.  

Foods to Eliminate or Evalulate with a Tree Nut Allergy

You must be particularly careful living with a tree nut allergy as they can appear in unexpected places or exist as the result of cross contamination. 

  • Tree nuts are found in many types of cereal.  
  • Many coffee shops offer drinks that have tree nut ingredients (hazelnut falvoring, almond milk, etc.) which also increase the risk of cross contamination if ordering a product that does not contain tree nuts.  
  • Barbeque sauce may contain tree nuts. 
  • Many desserts contain tree nuts.  Many popular ice cream flavors contain tree nuts.  An ice cream parlor is somewhere where the risk of cross contamination of tree nuts would be extremely high.
  • Bakeries often have cross contamination unless it is a bakery that is dedicated to producing tree nut friendly products. 
  • Personal care products such as soap and lotion may also contain tree nuts. Natural sponges or brushes may be made from walnut shells.

Some Possible Food Sources which Do Contain Tree Nuts or Are Likely to Contain Tree Nuts

  • Alcoholic Extracts 
  • Almonds
  • Anacardium nuts
  • Artificial Nuts
  • Beechnut
  • Black Walnut Hull extract 
  • Brazil Nut
  • Butternut
  • Cashew
  • Chestnut
  • Chinquapin
  • Coconut (read more on coconut below)
  • Gianduja
  • Ginko Nut
  • Hazelnuts/Filbert
  • Hickory Nut
  • Lichee/lychee nut/litch
  • Macadamia Nuts/Bush (Queensland nut)
  • Mandelonas
  • Mortadella (lunch meat that often contains pistachios)
  • Marzipan
  • Nangai nut
  • Nut extracts (example: almond extract)
  • Nut butters (example:  almond butter)
  • Nut Meal
  • Nut meat
  • Nut milk  (example: almond milk)
  • Nut oils
  • Nut paste
  • Nut pieces
  • Pecans
  • Pesto
  • Pili Nut
  • Pine nuts (pine nuts has many other names such as Indian, pignoli, Indian nut, pigñolia, pignon, pinyon nut, and piñon nut.
  • Pink Peppercorn (also known as Rose Pepper, Brazilian Pepper, Christmasberry, among other names)
  • Pistachio
  • Praline
  • Shea Nut
  • Walnut

This list is not all inclusive.

Foods to eliminate or investigate with a tree nut allergy

If I have a Tree Nut Allergy Does it Mean I Need to Avoid All Tree Nuts?

While it is true that individuals with tree nut allergies may only be allergic to specific tree nuts, generally they are told to avoid all tree nuts because food manufacturers often process many different types of tree nuts in their facilities.  This makes risk of cross contamination high.

Individuals who are allergic to one tree nut have about a 50% chance of being allergic to other tree nuts (2).

Certain types of tree nuts are more likely to cause an allergic reaction.  These nuts are walnuts, almonds, hazelnut, cashew, pecan, and pistachio.  

Individuals with a cashew allergy are more likely to also have an allergic reaction to pistachios.  This is because cashews and pistachios belong to the same botanical family.

The same is true for walnuts and pecans.  If you are allergic to walnuts you are more likely to be allergic to pecans because they belong to the same botanical family.

Talk with your Board Certified Allergist to get specific guidance about your situation and to seek guidance on which tree nuts you need to avoid.

Tree Nuts are Not the Same as Peanuts

Tree nuts grow on trees.  Peanuts are legumes and grown underground.    

Having a peanut allergy does not necessarily mean that you will have a tree nut allergy.  A tree nut allergy is separate from a peanut allergy.  However, it isn’t uncommon to have both a tree nut allergy and a peanut allergy.

Approximately 40% of children with a peanut allergy also have a tree nut allergy (4).

If I have a Tree Nut Allergy Do I Need to Avoid Seeds?

A seed allergy is different from a tree nut allergy.  Talk with your Board Certified Allergist if you feel you have an allergy to seeds.

Can I have Nutmeg if I have a Tree Nut Allergy?

Most individuals with a tree nut allergy can have nutmeg.  The American College of Allergy, Ashthma, & Immunology notes that nutmeg is derived from a seed, not a nut. In most cases nutmeg can safely be consumed by individuals with a tree nut allergy. Talk with your Board Certified Allergist.

Can I have Coconut with a Tree Nut Allergy?

Coconut is a particularly confusing topic in the world of food allergies.  The FDA identifies coconut as a tree nut.  Therefore, food labels will list coconut as a tree nut.

However, medical literature shows that most individuals who are allergic to coconut are often not allergic to tree nuts.  The number of individuals with a coconut allergy is also relatively low.  

Of course, discuss coconut specifically with your Board Certified Allergist to see if coconut should be eliminated from your diet.

You can read more about coconut in another one of my blog posts, “Is Coconut a Nut  What you Probably Don’t Know.”  

Pink Peppercorn

Individuals with a cashew allergy may want to exclude pink peppercorn (also known as Rose Pepper, Brazilian Pepper, Christmasberry among other names).  

The pink peppercorn is not a peppercorn as its name implies.  It is part of the Anacardiaceae botanical family which is also in the same botanical family as cashews and pistachios.

Talk to your Board Certified Allergist about possible risk for an allergic reaction when consuming pink peppercorn with a tree nut allergy.

Alcohol Consumption with a Tree Nut Allergy

Consuming alcoholic beverages can be an area of particular concern with a tree nut allergy. Alcoholic beverages do not have the same labeling laws as food.  Most alcoholic beverages companies do not have to follow FALCPA labeling requirements.  Read more about FALCPA below.

Alcoholic beverages may have nut flavorings such as almond.  For example, amaretto may contain almonds.

Frangelico usually contains a hazelnut liqueur.

If the label on alcohol lists “botanicals” or “natural flavors” as an ingredient on the label, it is wise not to consume. You will need to call the manufactuerer to discuss what ingreidents are used.

About FALCPA:  Food Allergy Labeling

The Food Allergen Labeling and Consumer Protection Act (FALCPA) was created in 2004.  FALCPA identified the following foods as major food allergens:  milk, eggs, fish, shellfish, peanuts, tree nuts, wheat, and soy.

Effective January 1, 2023, the FASTER Act  (the Food Allergy Safety, Treatment, Education, and Research Act) was signed into law, adding sesame as the 9th major food allergen recognized in the U.S. 

FALCPA requires that foods or ingredients that contain major food allergens be labeled with the name of the allergen source.   The law also requires the type of tree nut be identified (example:  pecans).

FALCPA states that major food allergens should be listed in one of three ways:

  1. In the ingredient list, using the allergen’s common name. 
  2. By  citing the word “Contains” followed by the name of the major food allergen.
  3. In the ingredient list in parentheses after a less common name of ingredient that may contain an allergen.  

Again, discuss with your provider which foods you should avoid with a tree nut allergy.

Made in a Facility/Cross Contamination Statements for Tree Nuts

Food manufacturers may use equipment to produce multiple products.  This may lead to cross contamination of allergens.  Some manufacturers disclose this information and others do not.  This is true for both FALCPA and non-FALCPA allergens.

Cross contamination statements are not required in the U.S.  Call the manufacturer to learn about their manufacturing practices.

Cross contamination is a particularly important concern with a tree nut allergy.  Items that contain peanuts may have come in contact with tree nuts.

Nut butters, like sunflower seed butter or soy nut butter, may also have risk for cross contamination.  Be sure to check with the manufacturer about risk of cross contamination.

Be sure to ask a lot of questions when dining out.  The risk of cross contamination may be high at certain restaurants.

It is imperative to check the food label every time.  Tree nuts can be in many products.

Tree Nuts in Arts and Crafts

Arts and Crafts supplies may also contain tree nut.  Something like decorating a gingerbread house could be dangerous if labels are not read prior to participating.

Bird seed used in some bird feeder arts and crafts may contain tree nuts.

Be sure to ask questions if you have a child with a tree nut allergy who will participate in arts and crafts.  

Be sure to help educate daycare teachers, elementary teachers and other community members about the risk of food allergies in arts and crafts.

You may want to share this article, Allergens in Arts and Crafts, with others.

Tree Nut Allergy Treatment

  1. Always read food labels closely and look for ingredients that indicate tree nuts.
  2. Avoid all foods related to your allergy.  Learn less common names for your particular food allergy.
  3. Become familiar with labeling laws.
  4. Talk to your Board Certified Allergist
  5. Be mindful of risk for cross contamination
  6. Be prepared to treat your tree nut allergy in the case of accidental ingestion.  Be sure to have not one, but two doses of epinephrine available when eating.  Always call 911 if epinephrine is given.
  7. Talk to your doctor about how to treat symptoms of an allergic reaction.  

Final Thoughts

Tree nut allergy symptoms can vary from person to person, but it is not unusual to have serious reactions with accidental ingestion.  It is imperative to learn how to manage your tree nut allergy.

Special consideration needs to be paid when visiting coffee shops, bakeries, and ice cream parlors.  Risk for tree nut cross contamination can be very high at these types of establishments.  

If you think you may be allergic to tree nuts see a Board Certified Allergist.
Like this post?  Make a comment.  Stay in touch by subscribing to my email list.  

Last Updated on March 24, 2023 by Amber DeVore, RD, CSSD, CLT

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