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Living with a Tree Nut Allergy

An estimated 1.8 million Americans have an allergy to tree nuts. Allergic reactions to tree nuts are among the leading causes of fatal and near-fatal reactions to foods. Tree nuts include, but are not limited to, walnut, almond, hazelnut, coconut, cashew, pistachio, and Brazil nuts. These are not to be confused or grouped together with peanuts, which are a legume, or seeds, such as sunflower or sesame.

Like those with peanut allergies, most individuals who are diagnosed with an allergy to tree nuts tend to have a lifelong allergy.

Some Unexpected Sources of Tree Nuts
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Salads and salad dressing
Barbecue sauce
Breading for chicken
Meat-free burgers
Fish dishes
Pie crust
Mandelonas (peanuts soaked in almond flavoring)
Mortadella (many contain pistachios)

Keep in Mind

Many experts advise patients allergic to tree nuts to avoid peanuts and other tree nuts because of the high likelihood of cross-contact at processing facilities, which process peanuts and different tree nuts on the same equipment. Further, a person with an allergy to one type of tree nut has a higher chance of being allergic to other types.

Tree nuts may be found in a wide range of unexpected foods for flavor or consistency. If ingredient information is not provided for a particular food or you question its accuracy, avoid the food completely.

Younger siblings of children allergic to tree nuts may be at increased risk for allergy to tree nuts.
Tree nuts can cause severe allergic reactions. Always carry epinephrine is your doctor prescribes it.

Commonly Asked Questions

Should coconut be avoided by someone with a tree nut allergy?

Discuss this with your doctor. Coconut, the seed of a drupaceous fruit, has typically not been restricted in the diets of people with tree nut allergy.

Is nutmeg safe?

Nutmeg is obtained from the seeds of the tropical tree species Myristica fragrans. It is generally safe for an individual with a tree nut allergy.

Should water chestnuts be avoided?

The water chestnut is not a nut; it is an edible portion of a plant root known as a corm. It is safe for someone who is allergic to tree nuts.

How to Read a Label for a Tree Nut Free Diet

All FDA-regulated manufactured food products that contain a tree nut as an ingredient are required by U.S. law to list the specific tree nut on the product label.

Avoid foods that contain nuts or any of these ingredients
Artificial nuts
Brazil Nuts
Filberts - Hazelnuts
Gianduja (a chocolate-nut mixture)
Ginkgo Nut
Hickory Nuts
Litchi - lichee - lychee nut
Macadamia nuts
Marzipanor almond paste
Nangai Nuts
Natural nut extract (e.g. almond, walnut)
Nut butters (e.g. cashew butter)
Nut meal
Nut paste (e.g. almond paste)
Nut pieces
Pili nut
Pine Nuts (also referred to as Indian, pignoli, pignolia, pignon, pinon and pinyon nuts)
Shea nut

Tree Nuts are sometimes found in the following

Black walnut hull extract (flavoring)
Natural nut extract
Nut distillates - alcoholic extracts
Nut oils (e.g. walnut oil, almond oil)
Walnut hull extract (flavoring)