Wikipedia – Tree nut allergy

Tree nut allergy

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Tree nut allergy
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Classification and external resources
ICD9 995.64, V15.05
MeSH D021184

Tree nut allergy, a hypersensitivity to dietary substances from tree nuts causing an overreaction of the immune system, may lead to severe physical symptoms.[1] Tree nuts include almonds, Brazil nuts, cashews, chestnuts, filberts/hazelnuts,macadamia nuts, pecans, pistachios, pine nuts,[2] and walnuts.

People with tree nut allergy are seldom allergic to just one type of nut,[citation needed] and are therefore usually advised to avoid all tree nuts, even though an individual may not be allergic to all varieties of tree nuts. Someone allergic to walnuts or pecans may not have an allergy to cashews or pistachios, even though close biological relatives often share related allergenic proteins. The severity of the allergy varies from person to person, and exposure can increase sensitization. For those with a milder form of the allergy, a reaction which makes the throat feel like cotton may occur .[citation needed] The raw nut protein usually causes a more severe reaction than the oil, and extra roasting or processing can reduce the allergic reaction. Those diagnosed with anaphylaxis will have a more immediate mast cell reaction and be required to avoid all exposure to any allergen-containing products or byproducts, regardless of processing, as they are prone to even greater sensitivity. An allergy test or food challenge may be performed at an allergy clinic to determine the exact allergens. New immunotherapy treatments are being developed for tree nut allergy.

Tree nut allergy is distinct from peanut allergy, as peanuts are considered legumes, whereas a tree nut is a hard-shelled fruit of certain plants.

This allergy tends to be lifelong; recent studies have shown that only about 9% of children outgrow their tree nut allergy.[2]

Hazelnut has been used as a model tree nut in the study of tree nut allergies.[1]

Prevention and treatment[edit]

In the United States, the federal Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that any packaged food product that contains tree nuts as an ingredient must list the specific tree nut on the label.[2] Foods that almost always contain tree nuts include pesto, marzipan, Nutella, baklava, pralines, nougat, gianduja, and turrón. Other common foods that may contain tree nuts include cereals, crackers, cookies, baked goods, candy, chocolates, energy/granola bars, flavored coffee, frozen desserts, marinades, barbecue sauces, and some cold cuts, such as mortadella. Tree nut oils (especially shea nut) are also sometimes used in lotions and soaps. Asian and African restaurants, ice cream parlors, and bakeries are considered high-risk for people with tree nut allergy due to the common use of nuts and the possibility of cross contamination. There has been a single documented case of pink peppercorns (often used in four-blend peppers) causing an allergic reaction in those with nut allergies.[3][4] Pink peppercorn is not a true pepper, but dried roasted berries derived from Schinus terebinthifolius, a flowering plant in the familyAnacardiaceae, native to South America. Common names include Brazilian Pepper, Rose Pepper and Christmasberry. Pink peppercorns are used as a spice to add a mild pepper-like taste to foods. It may potentially cause an irritating skin effect and has been associated with atopic dermatitis in canines. Interestingly, S. terebinthifolius is a member of the family Anacardiaceae, which include plants in the genera Anacardium (cashew) and Pistacia (pistachio). No allergens from this plant have been characterized but there is potential for cross-reactivity among different members of the Anacardiaceae family.

Treatment usually involves an exclusion diet and vigilant avoidance of foods that may be contaminated with tree nuts, nut particles, or oils. The most severe nut allergy reaction is anaphylaxis,[5] an emergency situation requiring immediate attention and treatment with epinephrine.

Tree nut alternatives[edit]

Since many people with tree nut allergies also have peanut allergies, and peanut butter is a popular derivative of peanuts and widely used product, especially in the United States, many schools offer peanut-free menu options or implement entirely nut-free policies.[6] For instance, sunflower seed butter can provide an alternative in schools where peanut butter and peanuts have been banned. However, a small number of people with tree nut and/or peanut allergies may also be allergic to sunflower seed butter. According to one study a person with a known peanut allergy suffered an acute reaction to a “nut-free” butter containing sunflower seeds.[7]

From a nutritional perspective, sunflower butter contains almost four times as much vitamin E as peanut butter, and about twice as much iron, magnesium, phosphorusand zinc. Peanut butter contains higher levels of protein and slightly less sugar and fat.[8]

Sunflower butter, or sunflower seed butter, is a food paste made from the oil of sunflower seeds.[9] Leading brands in the United States include SunButter and Trader Joe’s sunflower seed butter.

See also[edit]


  1. ^ Jump up to:a b Birmingham NP, Parvataneni S, Hassan HM, et al. (2007). “An adjuvant-free mouse model of tree nut allergy using hazelnut as a model tree nut”. Int. Arch. Allergy Immunol. 144 (3): 203–10. doi:10.1159/000103993. PMID 17570928.
  2. ^ Jump up to:a b c Food Allergy Research and Education
  3. Jump up^ Kim and Minikes, World Allergy Organization Journal, Published online 17 Feb 2012
  4. Jump up^ Ehlert et al., 19 Mar 2008, Food Analytical Methods, “Detection of Cashew Nut in Foods by a Specific Real-time PCR Method”
  5. Jump up^ National Report of the Expert Panel on Food Allergy Research, NIH-NIAID 2003
  6. Jump up^ Groce, Victoria (2008-06-09). “Why is My Child’s School Nut-Free? What food can she bring?”. Retrieved 2011-03-03.
  7. Jump up^ Hsu, Denise (2007). “Is “nut-free” sunflower seed butter safer for children with peanut allergy?”. The Medical Journal of Australia 198 (9): 542–543.
  8. Jump up^ Thomas, R.G. “Sunflower Seed Butter and Almond Butter as Nutrient-Rich Alternatives to Peanut Butter”. USDA. Retrieved 2012-11-12.
  9. Jump up^ Peabody, Erin (2005-05-17). “Sunflower Seed Butter Improves As It Spreads Across America”. USDA. Retrieved 2012-11-12.

External links[edit]


Tree Nut Allergy


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.

Tree Nut Allergy Symptoms

  • Abdominal pain, cramps, nausea and vomiting
  • Diarrhea
  • Difficulty swallowing
  • Itching of the mouth, throat, eyes, skin or any other area
  • Nasal congestion or a runny nose
  • Nausea
  • Shortness of breath
  • Anaphylaxis, a potentially life-threatening reaction that impairs breathing and can send the body into shock

For more information on tree nut allergy symptoms click here.

Tree Nut Allergy Triggers

  • Tree nuts
  • Tree nut products, including nut oils and butters

Tree Nut Allergy Management and Treatment

  • Avoid nuts and nut products; read ingredient labels carefully.
  • Administer epinephrine (adrenaline) as soon as severe symptoms develop.

For more information on tree nut allergy management and treatment click here.


An allergy to tree nuts is one of the most common food allergies. Along with peanuts and shellfish, it is also one of the food allergens most frequently linked to anaphylaxis, a potentially life-threatening reaction that impairs breathing and can send the body into shock.

Symptoms of a tree nut allergy include:

  • Abdominal pain, cramps, nausea and vomiting
  • Diarrhea
  • Difficulty swallowing
  • Itching of the mouth, throat, eyes, skin or any other area
  • Nasal congestion or a runny nose
  • Nausea
  • Shortness of breath
  • Anaphylaxis (less common)

If you experience any of these symptoms after consuming tree nuts, see an allergist.


Because a tree nut allergy can cause a life-threatening reaction, an accurate diagnosis is essential. Your allergist will start by taking a medical history, asking about any previous allergic reactions and about any family history of allergies. Skin-prick tests and/or blood tests may be used to determine the presence of allergen-specific immunoglobulin E, an antibody that binds to allergens and triggers the release of chemicals that cause symptoms.

If those tests are inconclusive, your allergist may order an oral food challenge. In this test, a patient is fed tiny amounts of the suspected allergy-causing food in increasing doses over a period of time, under strict supervision in an allergist’s office or a food challenge center. Emergency medication and emergency equipment must be on hand during this procedure.

Management and Treatment

As with most food allergies, the best way to avoid triggering an allergic reaction is to avoid eating the offending item.

People who are diagnosed with an allergy to a specific tree nut may be able to tolerate other tree nuts, but allergists usually advise these patients to avoid all nuts. Tree nuts are often used as garnishes in salads, as an ingredient in Asian dishes, and as an ice cream topping. They may also be found in baking mixes, breading, sauces, desserts and baked goods.

Tree nuts are among the eight most common food allergens affecting adults and children, and are specifically mentioned in the Food Allergen Labeling and Consumer Protection Act (FALCPA) of 2004. This means that the presence of these items must be highlighted, in clear language, on ingredient lists. Some companies may voluntarily include information that their food products that don’t contain nuts were manufactured in a facility that also processes nuts, though such a statement is not required by law. It is important for people with tree nut allergies to read labels carefully.

Some alcoholic beverages may contain nuts or nut flavoring added in the distillation process. Most alcoholic beverages aren’t coveredby the FALCPA requirements; if “natural flavors” or “botanicals” are cited as an ingredient, you may need to call the manufacturer to determine whether that indicates the presence of nuts or nut flavoring.

Tree nut oils, which may contain nut protein, can be found in lotions, hair care products and soaps; those allergic to tree nuts should avoid using these products.

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