Tree Nut Allergy

Tree nut allergy is the second most common allergy in infants and young children. Approximately 0.4 to 0.5% of American children have a tree nut allergy. Tree nuts are a common allergen reported to cause fatal and near-fatal allergic reactions.

Tree nut allergy is usually life-long once acquired. Approximately 9% of children allergic to tree nuts may outgrow their allergy.

Children with a tree nut allergy must avoid that tree nut and all products containing that type of tree nut. Children with a tree nut allergy also must avoid anything containing traces of ingredients containing that tree nut. There is a potential of tree nut products having cross-contact other tree nuts and with peanuts. For this reason, your child's doctor may advise you to avoid all tree nuts and peanuts.

How to Read a Label for Tree Nuts

Always read the entire ingredient label to look for the names of the tree nut(s) you need to avoid. Tree nut ingredients may be within the list of the ingredients. Or tree nuts could be listed in a “contains” statement beneath the list of ingredients. Examples are "contains walnut" or "contains almond." This is required by the federal Food Allergen Labeling and Consumer Protection Act (FALCPA). Learn more about the U.S. food allergen labeling law.

FALCPA requires that all packaged foods regulated by the FDA must list the common names of tree nuts clearly on the ingredient label if it contains tree nuts. Advisory statements such as “may contain hazelnuts” or “made in a facility with tree nuts” are voluntary. Advisory statements are not required by any federal labeling law. Discuss with your doctor if you may eat products with these labels or if you should avoid them.

Did you know that marzipan, mortadella, and mandelonas all contain tree nuts? The FDA food allergen label law requires foods to state if they contain a major allergen such as tree nuts. But, there are many foods and products that are not covered by the law, so it is still important to know how to read a label for tree nut ingredients. Products exempt from plain English labeling rules: (1) Foods that are not regulated by the FDA. (2) Cosmetics and personal care items. (3) Prescription and over-the-counter medications. (4) Toys, crafts, and pet food.

CONTAIN TREE NUTS

The following ingredients found on a label indicate the presence of tree nuts. All labels should be read carefully before consuming a product, even if it has been used safely in the past.

COMMON TREE NUT NAMES (FDA LIST)

Almond
Beechnut
Brazil nut
Bush nut
Butternut
Cashew
Chestnut
Coconut*
Filbert
Ginko nut
Hazelnut
Hickory nut
Lichee nut
Macadamia nut
Nangai nut
Pecan
Pine nut
Pistachio
Shea nut
Walnut

COMPLETE LIST OF TREE NUT NAMES (BOTANICAL NAMES AND DERIVATIVES)

Almond
Almond paste
Anacardium nuts
Anacardium occidentale (Anacardiaceae) [botanical name, Cashew]
Artificial nuts
Beech nut
Brazil nut
Bertholletia excelsa (Lecythidaceae) [botanical name, Brazil nut]
Bush nut
Butternut
Butyrospermum Parkii [botanical name, Shea nut]
Canarium ovatum Engl. in A. DC. (Burseraceae) [botanical name, Pili nut]
Caponata
Carya illinoensis (Juglandaceae) [botanical name, Pecan]
Carya spp. (Juglandaceae) [botanical name, Hickory nut]
Cashew
Castanea pumila (Fagaceae) [botanical name, Chinquapin]
Castanea spp. (Fagaceae) [botanical name, Chestnut (Chinese, American, European, Seguin)]
Chestnut (Chinese, American, European, Seguin)
Chinquapin
Coconut*
Cocos nucifera L. (Arecaceae (alt. Palmae)) [botanical name, Coconut]
Corylus spp. (Betulaceae) [botanical name, Filbert/hazelnut]
Filbert
Fagus spp. (Fagaceae) [botanical name, beech nut]
Gianduja
Ginko nut
Ginkgo biloba L. (Ginkgoaceae) [botanical name, Ginko nut]
Hazelnut
Heartnut
Hickory nut
Indian nut
Juglans cinerea (Juglandaceae) [botanical name, Butternut]
Juglans spp. (Juglandaceae) [botanical name, Walnut, Butternut, Heartnut]
Karite (shea nut)
Lichee nut
Litchi chinensis Sonn. Sapindaceae [botanical name, Lichee nut]
Lychee nut
Macadamia nut
Macadamia spp. (Proteaceae) [botanical name, Macadamia nut/Bush nut]
Mandelonas
Marzipan
Mashuga nuts
Nangai nuts
Natural nut extract (for example, almond extract)
Nougat
Nu-Nuts®
Nut butters (e.g., Almond butter, Hazelnut butter, Brazil nut butter, Macadamia nut butter, Pistachio nut butter, Shea nut butter, Karike butter, as well as other nut butters)
Nut meal
Nutella ®
Nutmeat
Nut oil (e.g., Walnut oil as well as other nut oils)
Nut paste
Nut pieces
Pecan
Pigñolia
Pili nut
Pine nut
Pine nut (Indian, piñon, pinyon, pigndi, pigñolia, pignon nuts)
Pinon nut
Piñon or Piñon nut
Pinus spp. (Pineaceae) [botanical name, Pine nut/piñon nut]
Pistachio
Pistacia vera L. (Anacardiaceae) [botanical name, Pistachio]
Pralines
Prunus dulcis (Rosaceae) [bontanical name, almond]
Shea nut
Sheanut
Vitellaria paradoxa C.F. Gaertn. (Sapotaceae) [botanical name, Shea nut]
Walnut (English, Persian, Black, Japanese, California)

TREE NUTS ARE SOMETIMES FOUND IN

Artificial flavoring
Baked goods
Mortadella
Natural flavoring
Nougat
Pesto

However, if the product is an FDA-regulated food, the common tree nut name must appear on the label.

*Coconut

The FDA lists coconut as a tree nut. In fact, coconut is a seed of a drupaceous fruit. Most people allergic to tree nuts can safely eat coconut. Coconut allergy is reasonably rare. If you are allergic to tree nuts, talk to your allergist before adding coconut to or eliminating coconut from your diet.

Cross Reactivity: Do You Need to Avoid Other Foods?

Cross-reactivity occurs when the proteins in one food are similar to the proteins in another. When that happens, the body's immune system sees them as the same.

Tree nuts are in a different plant family than peanuts. Peanuts are legumes and are not related to tree nuts (almonds, walnuts, cashews, etc.). However, about 35% of peanut-allergic toddlers in the U.S. have or will develop a tree nut allergy. Doctors often recommend that young children avoid tree nuts if they are allergic to peanuts. This is because it is fairly common to be "co-allergic" to tree nuts if a child is allergic to peanuts.

There is a high degree of cross-reactivity between cashew and pistachio and between walnut and pecan. Most people who are allergic to one tree nut are not allergic to all tree nuts. But some doctors will advise their patients to avoid all tree nuts if allergic to one or more tree nuts. Check with your doctor to find out if you need to avoid all tree nuts.

Nutrition for a Nut-Free Diet

Tree nuts are a good source of protein, vitamins, and minerals in a child's diet. However, if your child needs to avoid nuts of any type, they should not be at nutritional risk since there are many other sources of protein to eat instead.

NUTRIENTS LOST WHEN AVOIDING TREE NUTS	SUGGESTED ALTERNATE SOURCES (if not allergic)
Protein, vitamins, minerals	Increase other protein foods such as meat, legumes, fish, poultry, eggs, dairy (if safe for your child); fruit, vegetables, and enriched grains

Tree Nut Substitutions

It is very easy to replace nuts in a recipe. There are many seeds and seed products available including sunflower butter and pumpkin seed butter. Roasted chickpeas can replace nut snacks. Pretzels can substitute for pecans in pecan pie.

Learn more about NUT SUBSTITUTES.