Allergies: Tree Nuts
The United States defines the following as tree nuts:
 Almonds
 Beechnuts
 Brazil nuts
 Bush nuts
 Butternuts (similar to walnuts)
 Cashews
 Chestnuts (does not include water chestnuts)
 Chinquapin nuts
 Coconut*
 Filberts/hazelnuts
 Ginkgo
 Hickory nuts
 Lychee nuts
 Macadamia nuts
 Nangai nuts
 Pecans
 Pili nuts
 Pine nuts
 Pistachios
 Shea nuts
 Walnuts
*In 2006, the US Food and Drug Administration (FDA) classified coconut as a tree nut.
However, the Food Allergy and Anaphylaxis Network does not recognize it as such. Many
people who are allergic to tree nuts can tolerate coconut without a problem.
Peanuts are not tree nuts
Peanuts are legumes. However, if you are allergic to peanuts, you have a 30%-60% chance of
also developing tree nut allergies. Many people with a tree nut allergy choose to avoid all nuts to
minimize the chances of cross-contamination.
Tree nut allergies
The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires manufacturers of
any processed food that contains tree nuts as an ingredient to list the specific tree nut on the
label. Often people are allergic to some tree nuts, but not to others.
Ethnic restaurants (such as Vietnamese, Chinese, and Indian restaurants), ice cream parlors, and
bakeries are considered high-risk because of the chance of cross-contamination, even if ordering
a tree-nut-free item. Tree nuts also can show up in hygiene products, such as shampoo and
lotions. Individuals will tree nut allergies should avoid these products. Shea nuts are the most
commonly used tree nut in hygiene products.
The average age for the first reaction to tree nuts is 36 months of age. The allergy tends to last
for life, with only 9% of people outgrowing it. In rare cases, tree nut allergy can cause a lifethreatening allergic reaction (anaphylaxis).
Symptoms of anaphylaxis include:
 Constriction of the airways
 Shock with a severe drop in blood pressure
 Rapid pulse
 Dizziness, lightheadedness, or loss of consciousness
 Full-body redness and warmth (flushing)
However, most people have discomfort, but not a life-threatening reaction, with uncomfortable
symptoms that include:
 Tingling in the mouth
 Hives, acne, itching, or eczema
 Canker sores or fever blisters
 Swelling of the lips, face, tongue, throat, etc
 Wheezing, runny nose, or trouble breathing (asthma)
 Abdominal pain, diarrhea, nausea, or vomiting
 Dizziness, light-headedness, fever, fatigue, or fainting
 Conjunctivitis or pinkeye
 Low blood pressure
Diagnosis of tree nut allergy
The following tests are used to diagnose a tree nut allergy:
 Skin test: Your skin is pricked and exposed to small amounts of the protein found in soy. If you
are allergic to tree nuts, you will develop a raised bump at the test location.
 Blood test: This blood test can measure your immune system’s response to tree nuts by
measuring the amount of certain antibodies in your blood.
Treatment of tree nut allergy
Treatments for individuals with tree nut allergies include:
 Avoidance of tree nuts
 Use of medications, such as antihistamines
 Emergency injections of epinephrine (adrenaline) in case of accidental ingestion
Foods most likely to contain tree nuts
If you have food nut allergies, these are foods that may contain tree nuts (check the labels):
 Cereals
 Crackers
 Cookies
 Candy
 Chocolates
 Energy bars
 Granola bars
 Trail mixes
 Baked goods, such as doughnuts and muffins
 Flavored coffee
 Frozen desserts
 Marinades
 Barbecue sauce
 Some cold cuts, such as mortadella
 Popcorn
 Specialty cheese spreads
 Some alcoholic beverages (because the FDA does not have jurisdiction over alcohol,
manufacturers of alcoholic beverages do not need to follow the same labeling laws regarding
listing of pine nuts as ingredients)
In addition to avoiding actual pine nuts, individuals with pine nut allergies also should watch out
for the following ingredients:
 Marzipan/almond paste
 Gianduja
 Nougat
 Nu-Nuts™
 Artificial nuts
 Pesto
 Nut meal
 Tree nut oil, such as walnut oil or pecan oil
 Natural extracts, such as pure almond or wintergreen extract (artificial or imitation extracts are
usually safe)
 Nut paste
 Nutella®
 Pesto sauce
 Hazlenut liqueur and coffee
 Frangelico® liqueur
 Almond mocha
 Amaretto
 Nutmeat
 Praline
 Caponata
Cross-contamination is most likely found in the following foods:
 Cookies
 Candies
 Cereals
 Ice cream, especially chocolate and mint flavors
 Dried soups
 Nut butters
 European chocolates
References and recommended readings
Allergic Child Publishing Group®. Tree nut allergy. Available at:
http://www.allergicchild.com/tree_nut_allergies.htm. Accessed September 14, 2009.
EatingWithFoodAllergies.com. Tree nut allergy. Available at:
http://www.eatingwithfoodallergies.com/treenutallergy.html. Accessed September 14, 2009.
Food Allergy Initiative. Tree nut allergy. Available at: http://www.faiusa.org/?page=treenuts.
Accessed September 14, 2009.
Kids With Food Allergies, Inc. Tree nut allergy avoidance list. Available at:
http://www.kidswithfoodallergies.org/resourcespre.php?id=60&title=Tree_nut_allergy_avoidanc
e_list. Accessed September 14, 2009.
Pong AH. Tree nut allergies. Available at:
http://www.calgaryallergy.ca/Articles/English/treenuthp.htm. Accessed September 14, 2009.
Review Date 12/09
G-1155