What causes allergies to tree nuts

Allergic reactions can be triggered by a wide range of foods. Theoretically almost any food may be implicated, but the most common culprits are peanuts and tree nuts. Tree nuts include cashews, almonds, Brazils, hazelnuts, walnuts, pecans and pistachios. About three-quarters of children allergic to nuts or peanuts will react on their first exposure.

Peanut allergy causes more problems than other food allergies because it is common (1 in 50 infants), exposure is hard to avoid and in some cases even trace amounts can trigger symptoms.

Peanuts are actually legumes. A little percentage of people with peanut allergy react to other legumes, such as peas, beans and lentils.

Care is needed, but most will discover they can tolerate these other legumes without problems.

More commonly, people with peanut allergy react to tree nuts. Hence, doctors often advise people with peanut allergy to avoid tree nuts, and vice versa.


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.

Peanut and tree nut allergy

Allergic reactions can be triggered by a wide range of foods. Theoretically almost any food may be implicated, but the most common culprits are peanuts and tree nuts. Tree nuts include cashews, almonds, Brazils, hazelnuts, walnuts, pecans and pistachios. About three-quarters of children allergic to nuts or peanuts will react on their first exposure.

Peanut allergy causes more problems than other food allergies because it is common (1 in 50 infants), exposure is hard to avoid and in some cases even trace amounts can trigger symptoms.

Peanuts are actually legumes.

A little percentage of people with peanut allergy react to other legumes, such as peas, beans and lentils. Care is needed, but most will discover they can tolerate these other legumes without problems.

More commonly, people with peanut allergy react to tree nuts. Hence, doctors often advise people with peanut allergy to avoid tree nuts, and vice versa.


The majority of allergic reactions to peanut and tree nuts are mild. Contact hives, eczema and vomiting are the most common complaints. Some sensitive individuals develop difficulty breathing due to asthma or throat swelling, or a drop in blood pressure.

This is known as anaphylaxis, and allergy to peanut or tree nuts is one of the most common triggers.

Is it life-long?

Peanut allergy was once thought to be life-long in every cases. But recently it has been shown that about 20 per cent of young children grow out of their peanut allergy by the age of five. Any five-year-old who has been free of peanut allergy symptoms for more than a year may possibly own outgrown the allergy.

The kid can be referred to an allergy specialist for “challenge testing”, in which peanuts are introduced to the kid in a controlled way. This will be carried out in a hospital setting.

Tree Nut Substitutions

It is extremely simple to replace nuts in a recipe. There are numerous 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.

Nutrition for a Nut-Free Diet

Tree nuts are a excellent source of protein, vitamins and minerals in a child’s diet.

However, if your kid needs to avoid nuts of any type, they should not be at nutritional risk since there are numerous other sources of protein to eat instead.

(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

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 diverse 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. own or will develop a tree nut allergy. Doctors often recommend that young children avoid tree nuts if they are allergic to peanuts.

What causes allergies to tree nuts

This is because it is fairly common to be «co-allergic» to tree nuts if a kid 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 every tree nuts. But some doctors will advise their patients to avoid every tree nuts if allergic to one or more tree nuts. Check with your doctor to discover out if you need to avoid every tree nuts.

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 kid is allergic to either peanuts or tree nuts, enquire 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 kid with an allergy to peanuts, tree nuts or both. In the 2002 survey, 1.2 percent of subjects said they had a kid with one or both of these allergies; five years earlier, in 1997, only 0.6 percent of respondents reported having a kid 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.

What causes allergies to tree nuts

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 kid 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 istration recognizes coconut as a tree nut. While allergic reactions to coconut own 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.

Use the Discover an Allergist tool to discover expert care for your tree nut allergy.

Tree Nut Allergy

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

Tree nut allergy is generally 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 every 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 every tree nuts and peanuts.


If you are travelling on an international flight, check that they do not serve peanuts as a snack as the airborne particles may cause a reaction.

The most likely cause of reactions in flight, however, is through eating peanuts or nuts present in airline food. This is solved by playing it safe and taking your own food on the plane.

Acknowledgements: Dr Jan Sinclair — Paediatric Immunologist, and Jennifer Heyward — Paediatric Dietitian, of Starship Children's Health, and the Anaphylaxis Campaign.
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Individuals with food allergy own an overreactive immune systemtowards aparticularfood.

Such a response happens due toan antibody calledIgE (Immunoglobulin E). Individuals suffering from food allergy often own a family history ofallergies.The most common food allergens are the proteins in cow’s milk, eggs, peanuts, wheat, soy, fish, shellfish and tree nuts.

The symptoms on food allergy may not depend on the quantity of allergenic food consumed and may even happen with consumption of tiny amounts. It is also significant to note that numerous allergens may cause symptoms even after they own been cooked, and even after undergoing the digestive process.

On the other hand, some otherallergens, typically certain fruits and vegetables, may only cause allergies when consumed raw.

In some food groups, such as seafood andtree nuts, a phenomenon called cross-reactivity may be seen. This implies that if an individual has an allergy to onemember of a food family, they may also beallergic to other members of the same food group. Interestingly, cross-reactivitymay not be as commonly seen infoods from animal groups. For example, it has been found that individuals who may own allergiesto cow’s milk may still be capable toeat beef.

Similarly, individuals with egg allergies may still be abletoeat chicken. It has also been found thatamong shellfish, crustaceans (shrimp, crab and lobster) are most likely to cause an allergic reaction. Other mollusks such as clams, oysters and scallops are somewhat lesscommonly associated with allergies.

Symptoms of Food Allergies:
Symptoms of allergic reactions are commonly dermatological in nature and may causeskin itching, hives and swelling. Vomiting and diarrhea are common gastrointestinal symptoms.

What causes allergies to tree nuts

Symptoms of the respiratory system generally happen onlyin conjunction withskin and gastrointestinal symptoms.

Severe Allergic Reactions:
Anaphylaxis is a serious allergic reaction that happens extremely quickly and needs immediate and urgent attention!The symptoms often includedifficulty in breathing, loss of consciousness and dizziness. If you noticeany of these symptoms,especially after eating, call 911 rightaway. It is imperative to seek medical care immediately (call 911). Don’t wait to see if your symptoms go away or get better on their own. Without immediate treatment and effective and expert medical care, anaphylaxis can be lethal.

It is essential to follow up with your allergist in such cases.

An allergist is the best qualified professional to diagnose food allergy. Your allergist will take a thorough medical history, followed by a physical examination. You may be asked about contents of the foods, the frequency, seasonality, severity and nature of your symptoms and the quantity of time between eating a food and any reaction.

Allergy skin tests may determine which foods, if any, trigger your allergic symptoms. In skin testing, a little quantity of extract made from the food is placed on the back or arm.

If a raised bump or little hive develops within 20 minutes, it indicates a possible allergy. If it does not develop, the test is negative. It is unusual for someone with a negative skin test to own an IgE-mediated food allergy.

In certain cases, such as in patients with severe eczema, an allergy skin test cannot be done. Your doctor may recommend a blood test.

What causes allergies to tree nuts

Untrue positive results may happen with both skin and blood testing. Food challenges are often required to confirm the diagnosis. Food challenges are done by consuming the food in a medical setting to determine if that food causes a reaction.

Another question that is commonly asked is whether children outgrow their food allergies. It has been reported that most children may outgrow  certain allergies such as those to soy, egg, cow’s milk, and wheat allergy, even if they own a history of a severe reaction.

About 20% of children with peanut allergy will outgrow it. About 9% of children with tree nut allergy will outgrow it. Your allergist can assist you study when your kid might outgrow a food allergy.


The best way to treat food allergy is to avoid the foods that trigger your allergy. Always check the ingredients when eating, especially when out of home. Carefully read labels that indicate food information.

Carefully read food labels. Always carry and know how to use injectable epinephrine and antihistamines to treat emergency reactions. Teach family members and other people shut to you how to use epinephrine! It is also significant to wear an ID bracelet that describes your allergy.

Food allergies can be confusing and isolating.

For support, you may contact the Food Allergy & Anaphylaxis Network (FAAN) at (800) 929-4040.

(Information only; not intended to replace medical advice; adapted from AAAAI)

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 capable to tolerate other tree nuts, but allergists generally advise these patients to avoid every 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 significant 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 covered by 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.

Fortunately, allergists are specially trained to assist identify these hidden sources of tree nut allergens.


Teenagers and young adults may be more at risk of life-threatening reactions than younger children — and this is more to do with risk-taking behaviour. But their allergies can be well managed so endless as they always carry prescribed medication, study how to use it, and are extremely vigilant when food is around.

What causes allergies to tree nuts

It is significant that children take age-appropriate control from an early age, and you can study more about this from our Letting Go booklet.

How to Read a Label for Tree Nuts

Always read the entire ingredient label to glance 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). Study more about the U.S.

food allergen labeling law.

FALCPA requires that every 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 every contain tree nuts?

The FDA food allergen label law requires foods to state if they contain a top 8 allergen such as tree nuts. But, there are numerous foods and products that are not covered by the law, so it is still significant 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.

What causes allergies to tree nuts


Brazil nut
Bush nut
Ginko nut
Hickory nut
Lichee nut
Macadamia nut
Nangai nut
Pine nut
Shea nut


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


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
Butyrospermum Parkii [botanical name, Shea nut]
Canarium ovatum Engl.

in A. DC. (Burseraceae) [botanical name, Pili nut]
Carya illinoensis (Juglandaceae) [botanical name, Pecan]
Carya spp. (Juglandaceae) [botanical name, Hickory nut]
Castanea pumila (Fagaceae) [botanical name, Chinquapin]
Castanea spp. (Fagaceae) [botanical name, Chestnut (Chinese, American, European, Seguin)]
Chestnut (Chinese, American, European, Seguin)
Cocos nucifera L. (Arecaceae (alt. Palmae)) [botanical name, Coconut]
Corylus spp. (Betulaceae) [botanical name, Filbert/hazelnut]
Fagus spp.

(Fagaceae) [botanical name, beech nut]
Ginko nut
Ginkgo biloba L. (Ginkgoaceae) [botanical name, Ginko nut]
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]
Mashuga nuts
Nangai nuts
Natural nut extract (for example, almond extract)
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 ®
Nut oil (e.g., Walnut oil as well as other nut oils)
Nut paste
Nut pieces
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]
Pistacia vera L.

What causes allergies to tree nuts

(Anacardiaceae) [botanical name, Pistachio]
Prunus dulcis (Rosaceae) [bontanical name, almond]
Shea nut
Vitellaria paradoxa C.F. Gaertn. (Sapotaceae) [botanical name, Shea nut]
Walnut (English, Persian, Black, Japanese, California)


Artificial flavoring
Baked goods
Natural flavoring

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


Contrary to their name, coconuts are not tree nuts but are monocotyledonous plants of the palm family Arecaceae.

Nut bearing trees, on the other hand, are dicots and are only distantly related to the palm species. Coconut rarely causes allergy. Most allergists will not propose coconut avoidance unless there has been an allergic reaction to coconut.

Nut-Free Recipes

Over 1100 nut-free recipes are available in KFA’s Safe Eats™ Recipes. Search for Nut-Free Recipes

Medical review February 2015.

Allergic reactions to tree nuts

An allergic reaction generally happens within minutes after being exposed to an allergen, but sometimes it can take put several hours after exposure.

Anaphylaxis is the most serious type of allergic reaction.

Symptoms of anaphylaxis generally include two or more of the following body systems:

  1. Gastrointestinal (stomach): nausea, pain/cramps, vomiting, diarrhea
  2. Skin: hives, swelling (face, lips, tongue), itching, warmth, redness
  3. Cardiovascular (heart): paler than normal skin colour/blue colour, feeble pulse, passing out, dizziness or lightheadedness, shock
  4. Respiratory (breathing):coughing, wheezing, shortness of breath, chest pain/tightness, throat tightness, hoarse voice, nasal congestion or hay fever-like symptoms (runny itchy nose and watery eyes, sneezing), trouble swallowing
  5. Other:anxiety, sense of doom (the feeling that something bad is about to happen), headache, uterine cramps, metallic taste

If you own an allergy to tree nuts, hold an epinephrine auto-injector (e.g., EpiPen®) with you at every times.

Epinephrine is the first-line treatment for severe allergic reactions (anaphylaxis).

Note: The above lists are not finish and may change.

Emerging Allergen Reporting Tool

If your kid has had a reaction in the final 12 months to a food other than a priority allergen, participate in an significant research survey. Your participation will assist researchers, and advocacy groups love ours, better understand emerging allergens.

Study more and take the survey

Quick facts

  1. Peanuts are part of the legume family and are not considered a tree nut.
  2. Tree nuts are considered priority allergens by Health Canada.
  3. Some people with a tree nut allergy may be allergic to more than one type of tree nut.

  4. Tree nuts considered as priority allergens include almonds, Brazil nuts, cashews, hazelnuts, macadamia nuts, pecans, pine nuts (pignolias), pistachio nuts and walnuts.
  5. Priority food allergens are the foods that cause the majority of allergic reactions.
  6. People who are allergic to tree nuts generally avoid every nuts and peanuts because of the risk of cross contamination.


  1. A coconut is a seed of a fruit and nutmeg is obtained from the seeds of a tropical tree.

  2. Coconut and nutmeg are not considered tree nuts for the purposes of food allergen labelling in Canada and are not usually restricted from the diet of someone allergic to tree nuts.
  3. However, some people allergic to tree nuts own also reacted to coconut and nutmeg. Consult your allergist before trying coconut- or nutmeg-containing products.


Be Allergy-Aware: How to avoid tree nuts

  • Read ingredient labels every time you purchase or eat a product. If the label indicates that a product “Contains” or “may contain” tree nut, do not eat it.

    If you do not recognize an ingredient, if there is no ingredient list available, or if you don’t understand the language written on the packaging, avoid the product.

  • According to Health Canada:
    1. If a tree nut is part of the ingredients, the specific tree nut(s) must be declared by their common name (almond, Brazil nut, etc.) in the list of ingredients or in a separate “contains” statement immediately following the list of ingredients.
  • Do The Triple Check and read the label:
    1. Check with manufacturers directly if you are not certain if a product is safe for you.
    2. Once at the store before buying it.
    3. Be careful when buying imported products, since labelling rules differ from country to country.
    4. Always carry your epinephrine auto-injector.

      It’s recommend that if you do not own your auto-injector with you, that you do not eat.

    5. Again before you serve or eat the product.
    6. Once when you get home and put it away.
    7. Watch for cross-contamination, which is when a little quantity of a food allergen (e.g., almond) gets into another food accidentally, or when it’s present in saliva, on a surface, or on an object. This little quantity of an allergen could cause an allergic reaction.


    Common tree nuts

    1. Macadamia nuts
    2. Almonds
    3. Pistachios
    4. Pine nuts (pinon, pignolias)
    5. Pecans
    6. Hazelnuts (filberts)
    7. Chestnuts
    8. Brazil nuts
    9. Hickory nuts
    10. Cashews
    11. Walnuts


    Other names for tree nuts

    1. Nut meats
    2. Anacardium nuts
    3. Mandelonas (a nut-flavoured peanut confection)
    4. Queensland nut (macadamia)


    Possible sources of tree nuts

    1. Peanut oil
    2. Baked goods such as biscotti, cakes, cookies, crackers, donuts, granola bars, pastries and pies, baklava, baking mixes
    3. Spreads and Nut butters (e.g., Nutella and gianduia/gianduja)
    4. Salads and salad dressings
    5. Pesto sauce
    6. Natural flavourings and extracts
    7. Ice cream, gelato, frozen desserts, sundae toppings, frozen yogurt, pralines
    8. Barbecue sauce
    9. Smoke flavourings
    10. Health and Nutritional supplements, such as herbal remedies and vitamins
    11. Candies, such as calisson, mandelonas, marzipan, some chocolates, chocolate bars
    12. Nut-flavoured coffees, boiling cocoa, specialty drinks
    13. Main course dishes such as butter chicken, chicken korma, mole sauce, pad thai, satay, chili, other gravy dishes
    14. Cereals, granola, muesli
    15. Herbal teas
    16. Snack food love chips, popcorn, snack mixes, trail mix
    17. Hot cocoa and cocoa mixes
    18. Alcoholic beverages, such as Frangelico, amaretto liqueurs and others
    19. Vegetarian dishes


    Non-food sources of tree nuts

    1. Massage oils
    2. Beanbags, kick sacks/hacky sacks
    3. Pet food
    4. Cosmetics, skin and hair care products, lotions, soap, body scrubs, sun screens
    5. Bird seed
    6. Sandblasting materials


    Report a reaction

    If you believe you may own reacted to an allergen not listed on the packaging, you can report it to the Canadian Food Inspection Agency, which may issue a product recall.

    Discover out more on our Food Labelling page.