Last updated:
Subject:
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May 2008
Tree nuts and allergy
Porter Novelli Melbourne
NUT INDUSTRY POSITION PAPER
1. Context
Deaths due to nut-induced anaphylactic shock, a severe allergic reaction, are not common, but are widely
reported and the safety of nuts has consequently come under considerable scrutiny. In 2007 a nine year
old boy died from nut induced anaphylactic shock while on a school camp, and in Victoria a Coronial
inquest reported an open finding on Alex Baptist’s death caused by a nut induced anaphylactic shock
while at kindergarten. These two situations alone indicate nut allergy is of great concern, in particular to
children and their parents.
The Victorian government is the first within Australia to legislate that all schools and school workers be
trained to use the EpiPen® in the case of anaphylactic emergency. Anaphylaxis Australia has noted that
other States and Territories currently have guidelines in place. Many other governments may follow the
Victorian lead.
Recognising the potential threat of this issue the Federal government has also mandated that products
which may contain traces of nuts outline such on the label, and labelling is also being introduced in food
service outlets.
The Australian Food and Grocery Council Allergen Forum has prepared a Food Industry Guide to
Allergen Management and Labelling (2007) 1. The guide is supported by the Food Allergen Bureau and
provides recommendations for the production and labelling of foods containing allergenic substances
(including peanuts, tree nuts and sesame seeds and their products) as defined in the Australia New
Zealand Food Standards Code.
If you or a work colleague of any company within the Australian Nut Industry is approached by the media
for question or comment on nut allergies this document may help. Never respond immediately but first ask
what they would like to know, take their deadline and contact details and call them back once you have
formulated your response. Please make Nuts for Life aware of any media contact by calling 02 9460 0111
or emailing admin@nutsforlife.com.au
1
Australian Food and Grocery Council, Food Industry Guide to Allergen Management and Labelling (2007)
http://www.afgc.org.au/cmsDocuments/Allergen_Guide_2007.pdf
2. Background
While further research needs to be undertaken into nut allergy, it is estimated that one child in every 200
in Australia, could have a peanut allergy2. It’s understood that the amino acids - the building blocks of
proteins - ‘fold’ into particular three-dimensional shapes. Current research suggests that it’s the shape of
the protein that makes it allergenic to some individuals3.
Both of the case studies above have been reactions to peanuts. Nevertheless, tree nuts can also cause
severe reactions and those who are allergic to peanuts should also avoid tree nuts unless the absence of
allergy to other nuts is determined through carefully controlled and administered medical food challenge
tests.
Common allergy symptoms include; hives (rash and itching on the skin), eczema and vomiting. Severe
symptoms are more uncommon and include difficulty in breathing due to swelling of the mouth and throat
and a sudden drop in blood pressure otherwise known as anaphylactic shock.
Even once a nut allergy has been determined, it is often recommended that all nuts be avoided due to
food handling practices that may see one nut substituted or mixed with another without notice. If crosscontamination can be completely avoided, such as where nuts are in their shell, they may be deemed
safe to consume by those who know they are not allergic to that nut variety.
3. Position
Although tree nuts cause fewer reported allergic reactions than peanuts, the reactions are equal in onset
and severity to those for peanuts. Data on the incidence and prevalence of peanut and tree nut allergy is
not widely available. Studies in the United States and United Kingdom studies indicate that 0.6 to 0.7
percent of the population has an allergy to peanuts as opposed to the 0.4 to 0.6 percent allergic to at
least one tree nut.4
The population prevalence of tree nut allergy in Australia is unknown. However, two preliminary studies
conducted in NSW in 2002 have documented conservative tree nut allergy prevalence estimates of
0.24% and 0.73% respectively for pre-school aged children.5
The Australian tree nut industry recognises that this is a very serious issue and encourages ongoing
research to identify the triggers and help to find ways to reduce and ideally prevent severe allergic
reactions to tree nuts. Until that time the industry is committed to appropriately labelling products.
4. Key messages
2

The Australian tree nut industry acknowledges that tree nut allergy is a serious issue which
demands further research, especially within the Australian climate

Current data regarding adults and nut allergy is from the US and UK studies. These studies
indicate most nut allergies relate to peanuts (0.6 – 0.7 percent of the population), as opposed to
tree nuts (0.4 – 0.5 percent of the population)

While it is estimated that one child in every 200 in Australia, could have a peanut allergy, the
prevalence of tree nut allergy in Australia is unknown
Royal Children’s Hospital Melbourne, Peanut and Tree Nut Allergy, (October 2006)
http://www.rch.org.au/kidsinfo/factsheets.cfm?doc_id=10170
3
Nuts for Life, Food Safety Centre Allergen Resource Bureau Report (July 2006)
4
Nuts for Life, Food Safety Centre Allergen Resource Bureau Report (July 2006)
5
Food Standards Australia and New Zealand, Food Surveillance Australia New Zealand (Autumn/Winter 2006)

The only studies undertaken within Australia are preliminary studies. These estimate that among
pre-school aged children tree nut allergy prevalence is between 0.24% - 0.73%

The Australian Tree Nut Industry supports and complies with the Australian Food Standards
Code requirements to label all food products that may contain traces of nuts.
5. Secondary messages

The Australian Tree Nut Industry, through its health promotion program Nuts for Life, supports the
Food Allergen Bureau which is committed to sharing information within the food industry to aid in
the management of food allergens

While tree nut allergy can potentially be life threatening, it affects a very small percentage of the
population. This should not deter those who are not allergic from enjoying the taste and health
benefits of tree nuts

Research indicates that just a handful of nuts most days can significantly reduce blood
cholesterol and the risk of heart disease

Those who aren’t allergic to nuts should enjoy tree nuts as a regular part of a healthy diet
6. Supporting documents
Internal documents:
Food Safety Centre Allergen Resource Bureau Report (July 2006)
Nuts for Life Fact sheet on Nuts and Allergies
www.nutsforlife.com.au
ASCIA Fact Sheet on Tree Nuts and Allergy (November 2007)
http://www.allergy.org.au/images/stories/aer/infobulletins/pdf/peanut.pdf
ASCIA Position Statement on Allergy prevention in children (2005)
http://www.mja.com.au/public/issues/182_09_020505/pre10874_fm.html
Royal Children’s Hospital, Peanut and Tree Nut Allergy, (October 2006)
http://www.rch.org.au/kidsinfo/factsheets.cfm?doc_id=10170
7. Third party advocate/ allergy experts
For expert comment, the following contacts may be approached. Please call Nuts or Life in the first
instance but if not available access these experts. But do not give the media these contacts until you
have first called the experts yourself to brief them.
Jill Smith, Executive Officer
Australasian Society of Clinical Immunology & Allergy (ASCIA)
PO Box 450 Balgowlah NSW Australia 2093
Email: education@allergy.org.au
Ph: 04252 16402
Fax: 02 9907 9773
Website: www.allergy.org.au
Associate Professor Mimi Tang, Director,
Department of Allergy and Immunology Group Leader, Allergy and Immune Disorders, MCRI
Royal Children's Hospital, Flemington Rd, Parkville, VIC 3052
Tel +61 3 9345 5733
Fax +61 3 9345 6348
Email: mimi.tang@rch.org.au
8. Common questions and answers on nuts and allergies
These questions have been prepared by Rural Development Services and AgriQuality Australia Pty Ltd
on behalf of the Food Safety Centre Allergen Resource Bureau for Nuts for Life.
The questions have been hyperlinked to their answers. Place your mouse over the question, press down
the control button and left mouse click to see the answer for quick reference.
General Allergy / Nut Allergy
How common is tree nut allergy? Peanut allergy?
What is the difference between an allergy and an intolerance?
What is the difference between the “incidence” and the “prevalence” of nut allergies?
What causes nut allergies?
What are the symptoms of nut allergies?
Can nut allergies be cured?
How do you treat nut allergies?
Can nut allergies be fatal?
Nut Allergy and Diet
If you are allergic to one nut do you have to avoid all nuts?
If I have a nut allergy can I eat a small amount of nuts and be OK?
If I have a nut allergy can I still eat out at restaurants? Have takeaways?
If I have a nut allergy is there another way to get all the nutrition that nuts contain so I’m not missing
out?
Nut Allergy and Family
Are nut allergies a hereditary condition? If I have a nut allergy will I pass this onto my children?
If a relative is allergic to nuts will I also be allergic?
If I don’t know if I’m allergic to nuts should I avoid nuts anyway just in case?
Nut Allergy and Children
What should I do if my child has a reaction to eating nuts?
Will children grow out of nut allergies?
If I suspect that I or my child has a nut allergy who should I seek advice from?
Should I avoid eating nuts whilst pregnant? Breastfeeding?
Should all day care centres/ schools be nut free zones?
At what age should nuts be introduced into the diets of infants and toddlers?
How should I teach my child about their allergy condition so they aren’t tempted to try nuts just once?
Nut Allergy Testing
How do you test for nut allergies? Are there any “dodgy” tests I should avoid? What is the most reliable
testing method?
Food Labelling
Why do many food product labels now say “May contain traces of nuts”?
Where can I buy guaranteed nut-free products?
What other ingredients contain nuts that I may not be aware of?
General Allergy / Nut Allergy
How common is tree nut allergy? Peanut allergy?
Data on the incidence and prevalence of peanut and tree nut allergy is not widely available, and often
involves US-based research. Data from the United States and United Kingdom indicates that around 0.4
– 0.6% of the general population is allergic to at least one tree nut. This compares to an estimated 0.6% –
0.7% of the population having a peanut allergy and a total of 1.1% being allergic to either peanuts and/or
tree nuts.
Several studies indicate that the number of peanut and tree nut allergies may be growing larger over time.
It is reasonable to expect this US and UK data reflects the prevalence in the Australian population.
While it is estimated that one child in every 200 in Australia, could have a peanut allergy, the prevalence
of tree nut allergy in Australia is unknown.
Two preliminary studies conducted in NSW in 2002 have documented conservative tree nut allergy
prevalence estimates of 0.24% and 0.73% respectively for pre-school aged children, however further
research needs to be undertaken.6
What is the difference between an allergy and an intolerance?
True food allergy involves situations where the immune system mistakenly identifies a specific food or a
component of a food as a harmful substance. This causes certain cells to make antibodies to fight the
culprit food or food component (the allergen). The next time the food is eaten, the antibodies sense it and
signal the immune system to release histamine and other chemicals into the bloodstream. This happens
when even trace amounts of that food are eaten.
Other reactions to food that don't involve the immune system or the release of histamine aren't true food
allergies. Instead, they may be food intolerances. Because food intolerances may cause many of the
same signs and symptoms as food allergies do — such as nausea, vomiting, cramping and diarrhoea —
people often confuse the two.
It's important to distinguish food intolerance from a food allergy. If you have food intolerance, you can
usually eat small amounts of problem foods without a reaction as you can “tolerate” small quantities. By
contrast, if you have a true food allergy, even a tiny amount of the food may trigger a serious allergic
reaction.
What is the difference between the “incidence” and the “prevalence”
of nut allergies?
Prevalence of nut allergies is a measure of the number of people with a nut allergy within a population at
a given point in time. Incidence is a measure of the frequency of new occurrences of nut allergies in a
population over a period of time.
What causes nut allergies?
Almost all allergens are proteins, although it is not yet understood why some proteins cause allergic
reactions in some individuals whereas the majority of proteins can be consumed without side effects. The
interaction of amino acids (the building blocks of proteins) makes proteins “fold” into particular threedimensional shapes. These interactions are responsible for the physical and chemical characteristics of
the protein. Current research suggests that it is the shape of a protein that makes it allergenic to
sensitive individuals.
Much more research needs to be done in this area to confirm this theory and add to the understanding of
what makes an allergen an allergen.
6
Food Standards Australia and New Zealand (FSANZ), Food Surveillance Australia New Zealand Autumn/Winter 2006
What are the symptoms of nut allergies?
Signs and symptoms of any food allergy usually develop within an hour after eating the offending food
and may include:
 Hives and swelling of the skin, lips, or face
 Wheezing or severe breathing problems
 Rapid pulse
 Sweating
 Dizziness, fainting, loss of consciousness
 Nausea, vomiting, abdominal cramps, diarrhoea
 Rapid loss of blood pressure
 Extremely pale skin
Most allergic reactions are not life threatening. However, the most extreme allergic reaction – anaphylaxis
or anaphylactic shock – is life threatening. Symptoms of anaphylaxis may include difficulty breathing or
swallowing, hives, or swelling around the mouth or eyes. Anaphylaxis can be fatal within minutes, either
through swelling that shuts off airways or through a dramatic drop in blood pressure which results in
organ failure.
Can nut allergies be cured?
Food allergies, including nut allergies, cannot be cured, but the symptoms they cause may be able to be
treated and controlled. Most food allergy is acquired in the first few years of life, whereas the loss of food
allergy appears to be a far more variable process. In contrast to many other food allergies, it is estimated
that only up to 107 to 208 percent of people with tree nut or peanut allergies outgrow them.
How do you treat nut allergies?
Treatment requires completely avoiding any exposure to the nuts that cause allergic reactions in the diet
and in the environment. All nuts must be labelled where they are present as ingredients in a product, and
the Australasian food industry has taken several measures to improve this aspect of food safety.
Medication also may help relieve symptoms of milder allergic reactions, however the body's immune
system will continue to react when subsequently exposed to nuts. Subsequent reactions can sometimes
be much more severe than the initial reaction, which is why total avoidance of nuts is advised.
The possibility of inducing desensitisation in individuals with nut allergy is both controversial and
potentially dangerous. No standardised desensitisation programs for nuts are currently available.
After a severe allergic reaction or where a severe allergic reaction is possible, such as patients with coexistent asthma, a clinician may recommend keeping an anaphylactic kit handy at all times. The most
common kit, called EpiPen® contains a preloaded syringe of epinephrine (adrenalin) in a pen-like
instrument that is easy to inject. It is vitally important that patients and/or their carers have the information
and training required to use this in an emergency. Clinicians also recommend keeping an extra kit handy
wherever you go, since allergic reactions can happen anywhere and at any time.
Can nut allergies be fatal?
Allergy to nuts can cause anaphylaxis, or anaphylactic shock, which is an allergic reaction that can be
fatal within minutes, either through swelling that shuts off airways or through a dramatic drop in blood
pressure which results in organ failure. Peanuts and tree nuts are the foods responsible for the majority of
fatal, food-induced anaphylaxis.
Nearly all tree nuts, with the exception of almonds, pine nuts and macadamia, have been associated with
fatal allergic reactions.
7
Fleischer, D.M., Conover-Walker, M.K., Matsui, E.C., and Wood R.A. (2005) The natural history of tree nut allergy. Journal of
Allergy and Clinical immunology, 116(5)
8
Australian Society of Clinical Immunology and Allergy (ASCIA), Peanut and Tree Nut Allergy Fact Sheet (2007)
Nut Allergy and Diet
If you are allergic to one nut do you have to avoid all nuts?
If you have a known allergy to one type of nut, it is recommended that you avoid all nuts until the absence
of allergy to other nuts is determined through carefully controlled and administered medical food
challenge tests.
Even once this has been determined, it is often recommended that all nuts be avoided due to food
handling practices that may see one nut substituted or mixed with another without notice. If crosscontamination can be completely avoided, such as where nuts are in their shell, they may be deemed
safe to consume provided there is no allergy to that specific nut.
If I have a nut allergy can I eat a small amount of nuts and be OK?
Even very small amounts of a nut can lead to allergic reactions in susceptible people. As subsequent
reactions can sometimes be much more severe than previous reactions, total avoidance of nuts is
advised.
If I have a nut allergy can I still eat out at restaurants? Have
takeaways?
Provided you take a few precautions, you can still enjoy restaurant meals or takeaways even if you have
nut allergies. Do not rely on menu descriptions alone when ordering; Ask questions about ingredients and
how the meal is prepared to lower your risk of an allergic reaction. Also avoid restaurants that are likely to
use nuts in several dishes, for example, Asian meals and satay restaurants.
You might be uncomfortable making special requests at restaurants, especially if the service staff are
overextended. Discomfort in speaking up about food allergies is the most common reason people have
allergic reactions when dining out. Other reasons include:
 Meals are cooked with shared pans and utensils

The restaurant makes a mistake

The wait staff or chef is not educated about food allergies or hidden ingredients in food, such as
those found in dressings and sauces.

Plan and call ahead and learn to feel comfortable speaking up about your food allergy to reduce
your chances of having a problem. Allergy support groups can often provide additional advice and
resources such as communication cards (‘Chef cards’) that will help you explain your
requirements clearly to food service staff.

Specialised eateries that cater for allergic consumers are also becoming more common.
If I have a nut allergy is there another way to get all the nutrition that
nuts contain so I’m not missing out?
A balanced diet will give you the nutrients you need to maintain your health and wellbeing. By excluding
nuts and products that contain nuts you may need to pay extra attention to the foods that make up your
daily diet. If you believe you may be missing essential nutrients as a result of dietary restrictions you can
consult your doctor or local Accredited Practicing Dietitian (APD). See www.daa.asn.au to find your local
APD.
Nut Allergy and Family
Are nut allergies a hereditary condition? If I have a nut allergy will I
pass this onto my children?
The tendency to develop allergies is often hereditary, which means it can be passed down through your
genes. However, just because you, your partner, or one of your children have allergies doesn't mean that
all of your children will definitely get them, too. In addition, a person usually doesn't inherit a particular
allergy, just the likelihood of having allergies.
Some children have allergies even if no family member is allergic and if a child is allergic to one
substance, it's likely that he or she will be allergic to others as well.
If a relative is allergic to nuts will I also be allergic?
Since allergies could be hereditary, if a parent or other close relative has an allergy, a child is more likely
to develop an allergy. Some people may become sensitised to a food on their first exposure, whereas
others develop food allergies over time. This may be due to someone's surroundings or changes in their
body as they grow older.
If I don’t know if I’m allergic to nuts should I avoid nuts anyway just in
case?
It is important to keep in mind that only a small proportion of the population (approximately 0.6%, or 6 in
every 1000 people) have tree nut allergies. Also, most nut allergies become apparent in childhood.
Therefore, if you have no specific reason to suspect that you are allergic to nuts and your concern only
arises from media reports or from other people you speak to, there is no reason to avoid nuts – either
peanuts or tree nuts. This is especially true if you have eaten nuts in the past with no side-effects.
However, if you have a strong suspicion that you are allergic to nuts you should consult an allergy
specialist to have this reliably tested. If you have a known allergy to one type of nut, it is recommended
that you avoid all nuts until the absence of allergy to other nuts is determined through carefully controlled
and administered medical tests.
Nut Allergy and Children
What should I do if my child has a reaction to eating nuts?
Most reactions to nuts are either mild or moderately severe, involving reactions such as abdominal pain,
itchy throat, sneezing, or hives. However, if your child is having trouble breathing or passes out, call 000
immediately. Have your child lie down with their feet elevated to reduce the risk of shock until the
paramedics arrive.
If your child has been diagnosed with a nut allergy and you have an anaphylactic kit, give your child an
injection of epinephrine (adrenaline) immediately. When you receive your anaphylactic kit it is very
important to receive training and familiarise yourself with the safe response procedure prior to when you
need to use it.
Even if your child recovers quickly and seems to be normal, call your GP immediately. A secondary
reaction may occur hours after the initial reaction.
Will children grow out of nut allergies?
The majority of cases persist throughout adult life, however research has found that between to ten 9 to
2010 percent of people with tree nut or peanut allergies outgrow them.
9
Fleischer, D.M., Conover-Walker, M.K., Matsui, E.C., and Wood R.A. (2005) The natural history of tree nut allergy. Journal of
Allergy and Clinical immunology, 116(5)
10
Australian Society of Clinical Immunology and Allergy (ASCIA), Peanut and Tree Nut Allergy Fact Sheet (2007)
If I suspect that I or my child has a nut allergy who should I seek
advice from?
Your family doctor should be able to refer you to an allergy specialist or allergy clinic.
Should I avoid eating nuts whilst pregnant? Breastfeeding?
There is no definitive research concerning the effects of consuming nuts during pregnancy, and dietary
restrictions during pregnancy should be avoided.
As proteins are transferred to an infant via a mother’s breast milk, there is some evidence to suggest that
initial sensitisation to nuts may occur in this way. If there is a family history of atopic disorders (such as
asthma or eczema) or other allergies, breast-feeding mothers may wish to avoid nuts. Dietary restrictions
while breast-feeding should be avoided if there is no history of allergy.
Should all day care centres/ schools be nut free zones?
Complete bans of nuts and nut products from schools and day care centres can result in a number of
negative side-effects which should be considered. These include the potential for unnecessary
disagreements between parents, creating undue alarm in parents of non-allergic children despite the
relatively low prevalence of nut allergies, and creating a false sense of security rather than practicing
diligence. Education for both the children and school personnel is crucial in understanding how to
manage food allergies.
Among the strategies that have been implemented by a number of schools as an alternative to bans are:
 Meetings among parents, teachers and food service personnel to discuss the specific allergy
requirements

Establishment of non-food allergen tables and ‘no-swapping’ lunch policies

Staff trained in the administration of epinephrine (adrenaline) injections
At what age should nuts be introduced into the diets of infants and
toddlers?
Where there is a family history of atopic disorders (such as asthma or eczema) or other allergies, children
may have two to four times the likelihood of developing an allergy as compared to a family without allergic
parents. In these situations, it is generally recommended that potentially allergenic foods such as
peanuts and tree nuts be withheld from the children’s diets until approximately 6 years of age.
There is no evidence that restriction or avoidance of nuts is necessary for infants (once they start solids
from 6 months onwards) who are not at risk of developing allergy11. Caregivers, however, are advised
that whenever new foods are introduced to the infant’s diet, this is done one food at a time under
observation in case of adverse reactions. Nut butters are a good alternative to whole nuts as some
children may find whole difficult to chew and swallow and risk choking.
How should I teach my child about their allergy condition so they
aren’t tempted to try nuts just once?
Parents need to teach their children to manage their own lives and health conditions. For allergic children,
this includes asking questions, reading labels, making choices, and carrying and administering
medications. Children and teens with allergies need to feel comfortable and secure in their ability to make
those decisions. It is particularly important that their teachers, friends, girl/boyfriends and friend’s parents
are also made aware of their condition.
11
American Academy of Pediatrics. Effects of early nutritional interventions on the development of atopic disease in infants and
children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods and hydrolyzed
formulas. Pediatrics, 2003; 121;1:183-191. http://aappolicy.aappublications.org/cgi/reprint/pediatrics;121/1/183.pdf (accessed Jan
2007)
Education kits and resources are available through consumer support groups. It is advisable to join one
of these groups to learn from other parents in the same situation. In Australia, one of the best consumer
resources for families and individuals living with serious food allergies is Anaphylaxis Australia Inc. who
can be contacted on 1300 728 000.
Nut Allergy Testing
How do you test for nut allergies? Are there any “dodgy” tests I
should avoid? What is the most reliable testing method?
There are a number of different allergy-testing procedures utilised by practitioners. Allergies are most
commonly diagnosed using a skin test or blood test, depending on the age and condition of the patient.
Initially, the suspected allergen is placed on the skin and the skin is pricked with a plastic toothpick-like
instrument. If the child is allergic, a reaction (a welt that looks like a mosquito bite) will develop in 15 - 20
minutes. Skin testing can also be done by injecting the suspected allergen under the skin with a needle.
In hospital, medical staff can perform challenge tests by introducing the suspected allergen directly to see
if they can provoke and measure an allergic reaction.
For a suspected food allergy, staff use what is called the Double Blind Placebo Controlled Food
Challenge (DBPCFC) test. The offending food is concealed in a capsule or broth and, under careful
supervision, is given to the patient to see if they react to it. This should only be done in specialist allergy
clinics with full resuscitation equipment available. This is the most accurate food allergy test but it's time
consuming to perform. Sometimes shorter 'open challenges' are performed where the patient is aware of
what they are eating.
Clinical trials have shown that skin prick tests, blood tests and medically supervised food challenges have
reasonable reliability in diagnosing allergies. Food challenges are the most definitive method. Skin prick
and blood tests have been shown to produce a percentage of false negatives and false positives and
therefore cannot be taken as completely reliable.
A number of other tests have been shown to be much less reliable. Some practitioners perform tests that
have not been shown to have an acceptable degree of diagnostic reliability on repeated testing and
therefore they shouldn't be relied on without being substantiated by a more reliable method.
Some of these tests include the following:

VEGA testing - involves the measurement of disordered electromagnetic currents in the body to
certain substances

Applied kinesiology - tests muscle strength in the presence of various allergens, with a loss of
strength indicating an allergy

Hair analysis, provocation-neutralisation (Miller technique) and the auriculo-cardiac pulse tests
have all been assessed and found to be unreliable allergy tests

Leucocytotoxic tests - measure cellular changes in the blood after introduction of various food
allergens. These tests had a poor reliability for diagnosing allergies when they were subjected to
clinical trials
Food Labelling
Why do many food product labels now say “May contain traces of
nuts”?
The Australia New Zealand Food Standards Code 1.2.3 “Mandatory Warning and Advisory Statements
and Declarations” was gazetted in December 2002. This Standard stipulates that where any of the 9 key
food allergens, including peanuts and tree nuts are added to a food, it must appear on the label. Labels
must appear when the allergic substances are knowingly added to food as ingredients, components of
ingredients or processing aids and food additives.
In addition to this labelling, many food manufacturers choose to highlight the risk of accidental crosscontact between products that do contain allergens and products that do not contain allergens,
sometimes using statements such as “Made on the same line as products that contain nuts” or “May
contain traces of nuts”.
Where can I buy guaranteed nut-free products?
Several products are manufactured without nuts as ingredients and in facilities where nuts are not also
handled. Whilst it is recommended that you be extra vigilant when reading product labels, extra reassurance can be gained by contacting the manufacturer directly.
In addition, some manufacturers produce food specifically for the nut-free market. It is also worthwhile
contacting these manufacturers and asking them about their production process to ensure no possible
traces of nuts can enter the supply chain.
Dietitians associated with allergy clinics may be able to recommend specialist nut-free products, and it is
advisable to join an allergy support network such as Anaphylaxis Australia Inc. to seek recommendations
from other members.
What other ingredients contain nuts that I may not be aware of?
Nuts can be hidden in foods such as nut oils, nut essences or as nut flours in cooking. It is essential to
check the ingredients of all foods every time you purchase them in case ingredient changes have been
made since the last time you purchased it.
Examples of foods in which nuts can be hidden:
 African, Chinese, Indonesian, Japanese, Mexican, and Vietnamese dishes (which often contain
nuts or come into contact with nuts during meal preparation)
 Crushed nuts in sauces
 Certain chocolates, particularly caramels coated with chocolate
 Cakes may contain a nut essence or nut flours
 Pesto (an Italian sauce made with nuts)
 Nut butters and spreads
 All cakes and pastries with unknown ingredients, particularly carrot cake, pumpkin cake or pie,
and fruit and nut rolls
 Mandelonas (peanuts soaked in almond flavouring)
 Bouillon and Worcestershire sauce
 Praline and nougat
 Muesli and fruited breakfast cereals
 Vegetarian dishes
 Health food bars
 Artificial nuts (which could be nuts that have been deflavoured and reflavoured with another nut,
such as pecan or walnut)
 Marzipan (a paste made from ground almonds and sugar)
 Gravy
 Coated popcorn which may contain nut oil



Some ice cream toppings contain chopped nuts
Prepared salads and salad dressings
Foods bought in a bakery or delicatessen (where there is more risk of contamination; no
ingredients label and foods are unwrapped)
Other products that may pose a risk include:
 Certain cosmetic items such as lipsticks and lip balms, bath oils or similar products
 Some skin creams, including those for eczema, may contain nut oils - as these can be absorbed
through the skin, they can cause a reaction in a highly sensitive patient
 People with allergies should not handle nuts, for example, in bird feeders or when used in
artworks.