Tree Nut Avoidance Nutrition Therapy

Client Name ______Date ______RD/DTR ______Email ______Phone ______

Your child has been diagnosed with a tree nut allergy. The only treatment for tree nut allergy is to strictly avoid all food products that contain tree nuts as an ingredient.

Tree nuts are considered major allergens. All manufactured food products that are regulated by the Food and Drug Administration (FDA) and contain any tree nut as an ingredient must list the specific tree nut on the product label.

The following nuts are considered tree nuts under US law:

 Almond  Hickory  Beech nut  Lychee nut  Brazil nut  Macadamia nut  Butter nut  Pecan  Cashew  Pili nut  Chestnut  Pine nut (pignolia nut)  Chinquapin  Pistachio  Coconut  Shea nut  Filbert/hazelnut  Walnut  Ginkgo

Ask your child’s doctor whether your child should avoid all tree nuts or specific types.

Be aware that tree nuts, peanuts, and seeds are often processed on shared equipment. Therefore, there is a risk of cross-contamination or cross-contact among various types of tree nuts, peanuts, and seeds.

Tree nuts may be found in baked goods, cereals, crackers, cookies, candy, chocolates, energy bars, flavored coffee, granola bars, frozen desserts, smoothies and shakes, prepared foods, marinades, and barbeque sauces.

Before you buy any food product, always read the entire food label to make sure the product is safe. Remember that manufacturers may change ingredients and food preparation methods at any time.

Recommended Foods Check all labels and verify safe food preparation techniques to determine safety. Any food containing tree nuts is not recommended.

Food Group Recommended Foods Milk and Milk Milk (whole, reduced-fat, low-fat, fat-free) Products Cheese made without tree nut ingredients or potential for cross-contact with tree nuts Cream cheese Pudding made without tree nut ingredients or potential for cross-contact with tree nuts Sour cream Yogurt and ice cream made without tree nut ingredients or potential for cross-contact with tree nuts Meat and Other All fresh and frozen meats (beef, veal, lamb, pork) Protein Foods Fish and shellfish Poultry Eggs Dried beans and peas Seeds without added tree nut ingredients or potential for cross-contact with tree nuts

Peanut is not a tree nut, but there is a risk of peanut allergy in those with tree nut allergy. Ask your child's doctor if your child can have peanut or peanut products such as peanut butter. If allowed, choose those without potential for cross-contact with tree nuts. Grains Breads, other baked goods (brownies, cakes, cookies, muffins, etc.), cereals, crackers, noodles/pasta, pancakes, pretzels, rice, rolls, tortillas, waffles, and other grain foods without added tree nut ingredients or potential for cross-contact with tree nuts Vegetables All fresh, frozen, and canned vegetables prepared without tree nuts Fruits All fresh, frozen, and canned fruits prepared without tree nuts Fat and Oils Butter Margarine Vegetable oils (except tree nut oils) Vegetable oil spray Gravies, mayonnaise, sauces, and salad dressings made without tree nut ingredients or potential for cross-contact with tree nuts Beverages All beverages without tree nut ingredients or potential for cross-contact with tree nuts

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Other Pepper and salt Herbs and spices (including nutmeg, which is not a tree nut) Mustard, ketchup, and relish Flavoring extracts (except natural tree nut flavorings) Gelatin Honey Jam, jelly, marmalade, and preserves Sugar Maple syrup

Foods Not Recommended Check all labels and verify safe food preparation techniques to determine safety. Any food containing tree nuts is not recommended.

Food Group Foods Not Recommended Tree Nuts and Almond Ingredients Beech nut Containing Brazil nut Tree Nuts Butter nut Cashew Chestnut Chinquapin Coconut Filbert/hazelnut Ginkgo Hickory Lychee nut Macadamia nut Pecan Pili nut Pine nut/pignolia nut Pistachio Shea nut Walnut

Ask your child's doctor if the child should avoid all tree nuts or just specific tree nuts. Be aware there is a risk of cross-contact during processing of various tree nuts (and peanuts). If allowed, choose those without potential for cross-contact.

Peanut is not a tree nut, although those with tree nut allergy may be at risk for a peanut allergy. Ask your child's doctor if peanuts should be avoided.

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Milk and Milk Any with added tree nut ingredients Products Meat and Other Mortadella (a type of luncheon meat that contains Protein Foods pistachios) Any meat or other protein food with added tree nut ingredients Grains Breads, other baked goods (brownies, cakes, cookies, muffins, etc.), cereals, crackers, noodles/pasta, pancakes, pretzels, rice, rolls, tortillas, waffles, and other grain foods with added tree nut ingredients or potential for cross-contact with tree nuts Vegetables Fresh, frozen, and canned vegetables prepared with tree nuts Fruits Fresh, frozen, and canned fruits prepared with tree nuts Fat and Oils Tree nut oils (hazelnut, walnut, almond, etc.) Beverages Nut-flavored coffees (made with natural nut extracts) Almond milk Hazelnut milk Other beverages with tree nut ingredients Other Natural extracts such as almond or hazelnut extract Barbeque sauces and other marinades with tree nut ingredients Marzipan Nougat Artificial nuts Pesto Nut meal Gianduja Mandalona—peanut meal that is molded, shaped, and reflavored with a tree nut flavoring (typically almond or pecan)

Notes:

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Sample 1-Day Menu

Cheese omelet: 1 egg and 1 slice of cheddar cheese 1 slice whole grain toast with 1 teaspoon margarine and 1 teaspoon Breakfast strawberry jam ½ cup honeydew melon 4 ounces orange juice Ham sandwich: 2 ounces ham, whole wheat wrap with lettuce Pasta and tomato salad with 2 tablespoons Italian dressing Lunch Homemade brownie 1 cup low-fat milk Snack Mixed berry smoothie: 4 ounces low-fat milk and ½ cup mixed berries 2 ounces grilled chicken ½ cup baked sweet potato Dinner ½ cup zucchini Corn on the cob with 2 teaspoons margarine 1 cup low-fat milk

Notes:

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