In partnership with Primary Children’s Hospital Peanut and Tree Nut Allergy What is a peanut or tree nut allergy? Your child may need to avoid products that could A peanut allergy is an immune reaction to proteins have a high risk for cross-contamination. For this in peanuts. A tree nut allergy is an immune reaction reason your child may need to avoid all peanuts and to proteins in various tree nuts. Some children may tree nuts. be allergic to only certain types of tree nuts. Some Cross-reactivity can also occur. This is when the children may be allergic to both peanuts and various proteins in one food are similar to those in another. types of tree nuts. The immune system sees them as the same and can Some common symptoms of allergy reactions include: cause an allergic reaction. Your child’s doctor will best be able to tell you your child’s risk for cross-reactivity Skin: reactions. They can tell you whether or not to avoid • itchy red rash • flushing additional foods that may cause those reactions. • hives • swelling of face What do I look for when I read the • eczema food labels? Digestive system: 1 Labels on food, that are regulated by the FDA, • belly pain • severe nausea have to say if the food contains the 8 most • blood or mucous in • cramping common food allergens: milk, egg, soy, wheat, stools • itching or swelling of peanuts, tree nuts, shellfish, or fish. Always read • severe diarrhea the lips, mouth, tongue the ingredient list to be sure and check all food • vomiting or throat. labels carefully. Manufacturers may change ingredients without warning. Respiratory system (lungs): 2 • runny nose • asthma Allergen Advisory Statement—“May contain [allergen]” or “Produced in a facility that also • sneezing • throat tightening produces products containing [allergen].” • wheezing • difficulty breathing 3 Avoid any food product that contains an Cardiovascular system (heart): Advisory Statement for your child’s food allergies. • rapid heartbeat • passing out Below is an example of a food label: • low blood pressure Ingredients What do I do for my child with a Whole Oats, Brown Rice Syrup, Rice Crisps (Milled Rice, peanut or tree nut allergy? Sugar, Salt, Barley Malt), Diced Apples, Evaporated Cane Juice Syrup, Raisins, Roasted Soy Beans, Almond Butter, • A child with a peanut allergy must avoid all foods Honey, Pear and Grape Juice Concentrate, Brown Rice containing peanut and peanut product. Flour, Soy Protein Isolate, Glycerin, Natural Flavors, Cinnamon, Nonfat Milk • A child with a tree nut allergy must avoid specific Contains milk, nut and soy ingredients. Made on tree nuts and foods containing them. What to equipment that also processed peanuts and wheat. avoid depends on what type of tree nut allergy has been identified. 1 What are some names for peanuts Foods made with tree nuts and tree nuts on food labels? Almond milk Mandelonas Nut meal The following tables have names of ingredients Almond paste Marzipan Nutella® containing peanut, foods that may contain peanut, Artificial nuts Mashuga nuts Nutmeat the common names of tree nuts, and foods that may Caponata Mortadella Nut oil (e.g., Walnut oil as well be made with tree nuts. Cashew milk Natural nut extract as other nut oils (for example, Ingredients that contain peanut Chinquapin almond extract) Nut paste Coconut milk Nougat Nut pieces Arachic oil Ground peanuts Peanut butter morsels Gianduja Nu-Nuts® Pesto Hydrolyzed peanut Peanut flour Arachis protein Ginkgo biloba Nut butters (e.g., Pigñolia Almond butter, Arachis hypogaea Mandelonas Peanut Oil* (Cold Hazelnut milk Hazelnut butter, Pili nut pressed, extruded, Brazil nut butter, Mixed nuts Heartnut Pinon nut Artificial nuts or expelled) Macadamia nut Indian nut butter, Pistachio Piñon or Piñon nut Beer nuts Monkey nuts Peanut paste nut butter, Shea Pralines Nu nuts, flavored Peanut sauce nut butter, Karike Boiled peanuts nuts Lychee nut butter, as well as other nut butters) Crushed nuts Nut pieces Peanut syrup Artificial flavorings and natural flavorings may all be made with Crushed peanuts Nutmeat Spanish peanuts tree nuts; you may need to call the manufacturer to verify or avoid. Earth nuts Peanuts Virginia peanuts Goober peas Peanut butter Will my child get enough nutrients by Ground nuts Peanut butter chips avoiding peanuts or tree nuts? *Highly refined peanut oil will not be labeled as a major allergen on an ingredient statement, as these can be safely eaten by food Peanuts and tree nuts are a good source of protein allergic individuals. You will still need to avoid any expeller pressed, extruded or cold-pressed peanut oil. These types of oil do contain in a child’s diet. They also provide a source of peanut protein and must be listed on the label as an allergen. niacin, magnesium, vitamins E and B6, manganese, pantothenic acid, chromium, folate, copper and Foods that may contain peanut biotin. If your child needs to avoid nuts of any type it Artificial flavoring Enchilada sauce Hydrolyzed plant does not need to be a nutritional risk. There are many protein other sources of protein your child can eat instead of Ethnic foods: Hydrolyzed Baked goods African, Asian, vegetable protein peanuts and tree nuts. Your child can get vitamins Chinese, Indian, Candy Indonesian, Mexican, Marzipan and nutrients by consuming a variety of foods from Chili Thai, Vietnamese Mole sauce other food groups. Chocolate Fried foods Natural flavoring Crumb toppings Flavoring Nougat Nutrients Lost When Suggested Alternate Avoiding Peanut or Sources Egg rolls Graham cracker crust Tree Nut (if not allergic) Protein, Vitamins, Minerals Increase other protein foods Ingredients that contain peanut such as meat, fish, poultry, eggs, dairy (if safe for your Almond Coconut* Nangai nut child); fruit, vegetables, and whole and enriched grains Beechnut Filbert Pecan Brazil nut Ginko nut Pine nut Bush nut Hazelnut Pistachio What type of foods can my child eat? Butternut Hickory nut Shea nut The following tables list some general foods that Cashew Lichee nut Walnut are okay to eat and peanut or tree nut containing Chestnut Macadamia nut foods that should be avoided. Always read the food * The FDA lists coconut as a tree nut. In fact, coconut is a seed of a fruit. Most people allergic to tree nuts can safely eat ingredient list on all products you buy. coconut. Talk to your doctor before adding coconut to or 2 eliminating coconut from your diet. Foods you Foods you Foods you Foods you Foods you should NOT should NOT Foods you should NOT should NOT can eat eat (contain eat (contain can eat eat (contain eat (contain peanuts) tree nuts) peanuts) tree nuts) Beverages Fats • Carbonated Drinks • Almond milk • Bacon • Expeller pressed, • Coconut oil or extruded or cold spread • Coconut milk or • Cashew milk • Butter pressed peanut oil (if allergic) water • Coconut oil, spreads • Peanut butter • Nut butters • Flavored water • Coconut milk or (almond, cashew, water if allergic • Margarine etc.) • Flax milk • Hazelnut milk • Vegetable oils • Nut oils (walnut, • Fruit Juices (olive, avocado, hazelnut, canola, etc.) almond, etc.) • Hemp milk • Vegetable • Rice milk shortening • Soy milk Miscellaneous • Tea/Coffee • Chips • Baking mixes • Baking mixes Breads, Cereals, and Pasta (read label) (read label) • Condiments • Barbeque sauce, • Barbeque sauce, • Most commercial • Cold cereals • Granola (read (ketchup, marinades, marinades, breads (whole made with label) mustard, teriyaki sauces, teriyaki sauces, wheat, peanuts mayonnaise) etc. (read label) etc. (read label) sourdough, • Cold cereals potato, French, • Granola (read made with nuts • Frozen fruit bars • Cakes, cookies, • Black walnut hull etc.) label) (read label) Hard Candies muffins, etc. (read label) • Cold cereals • Boxed pasta • Breads with nuts • Gelatin type • Cakes, cookies, without peanuts meals (read label) desserts muffins, etc. or nuts • Boxed pasta (read label) meals (read • Hard Candies • Candy (read label) • Plain pasta • Boxed Pilafs label) noodles (read label) • Jams • Granola bars • Candy (read (read label) label) • Whole grains • Boxed Pilafs (rice, cous cous, (read label) • Pickles • *Lupinus albus • Flavored coffee quinoa, etc.) – lupin, lupine, • Popcorn lupini • Granola bars Dairy Products (read label) • Pretzels Veggie • Peanut sauce • Natural nut • Cow’s milk • Processed cheese • Processed cheese type puffs (read extracts (almond, (read label (read label label) • Trail mixes walnut, etc.) • Cream carefully) carefully) • Seasonings and • Nut distillates/ • Cottage cheese • Ice creams with • Ice creams with Herbs (read labels alcoholic extracts peanuts or made tree nuts or • Sour cream on prepackaged in facilities with made in facilities mixes) • Trail mixes peanuts with tree nuts • Sorbet (check for • Walnut hull • Kefir • Nougat • Nougat advisory extract (flavoring) • Cheese (read • Frozen Yogurt • Frozen Yogurt statement) label carefully) with peanuts or made with tree • Veggie type made in facilities nuts or nuts or puffs (read label) • Ice Cream - with peanuts made in facilities Homemade with tree nuts * Lupinus albus, or lupine is a legume that cross-reacts with • Pudding (read • Yogurt with tree nuts peanut at a high rate and should be avoided by peanut allergic label carefully) prepackaged patients. It does not fall under the labeling requirements for toppings peanuts. It can be found in seed and flour form. • Yogurt (read • Yogurt with label carefully) prepackaged Vegetables and Fruits toppings • All fresh fruits • Salad Kits with • Salad Kits with and vegetables peanuts nuts • Baby fruits and • Frozen • Frozen vegetables vegetables with vegetables with flavors/sauces flavors/sauces • Canned fruits (read label) (read label) and vegetables • Plain Frozen fruits and vegetables 3 Foods you Foods you Eating out can be a challenge with a peanut or tree Foods you should NOT should NOT nut allergy. can eat eat (contain eat (contain peanuts) tree nuts) Many restaurants use them either as a main ingredient Proteins or added to plain foods. Vegetarian, Japanese, • All plain eggs, • “Crusted” meats • Mortadella Chinese, Thai and other Asian type meals probably beef, chicken, fish, or fish have nut products in them.