TREE NUT ALLERGY Tree nut allergy is one of the most common food allergies in children and adults, and can cause a severe, potentially fatal allergic reaction (anaphylaxis). Tree nuts include, but are not limited to: almond, Brazil nut, cashew, hazelnut, macadamia, pecan, pine nut, pistachio and walnut. These are not to be confused or grouped together with peanut, which is a legume, or seeds, such as sunflower or sesame.

What is a food allergy? test results with the information given Severe Symptoms or Anaphylaxis in your medical history for a diagnosis. Food allergy is a serious medical These tests may include: LUNG: Shortness of breath, condition affecting up to 32 million wheezing, repetitive cough people in the United States, including ● Skin prick test 1 in 13 children. Food allergy happens ● Blood test HEART: Pale or bluish skin, when your body’s immune defenses ● Oral food challenge faintness, weak pulse, dizziness that normally fight disease attack a ● Trial elimination diet food protein instead. The food protein THROAT: Tight or hoarse throat, is called an allergen, and your body’s Oral food challenges are considered the trouble breathing or swallowing response is called an allergic reaction. gold standard for definitive diagnosis. MOUTH: Significant swelling of the How common are nut allergies? Depending on your medical history and tongue or lips initial test results, you may need to take Nine foods account for a majority of more than one test before receiving your SKIN: Many hives over body, reactions: milk, eggs, peanuts, tree nuts, diagnosis. widespread redness soy, wheat, fish, sesame and shellfish. Even trace amounts of a food allergen Signs and symptoms of an allergic GUT: Repetitive vomiting or severe can cause a reaction. Peanut and tree reaction to any food diarrhea nut allergies, which tend to develop in childhood, are usually lifelong. In the An allergic reaction to food can affect OTHER: Feeling something bad will U.S., approximately three million people the skin, the gastrointestinal tract, happen, anxiety, confusion report allergies to peanuts and tree the respiratory tract, and, in the most nuts. serious cases, the cardiovascular Severe symptoms, alone or in system. Reactions can range from mild combination with other symptoms, may How are tree nut allergies diagnosed? to severe, including the potentially be signs of anaphylaxis and require life-threatening condition known as immediate treatment. Suspected food allergies should always anaphylaxis. be evaluated, diagnosed, and treated What is the best treatment for tree nut by a qualified medical professional, Mild Symptoms allergy? such as a board-certified allergist. Your primary care provider may refer you to NOSE: Itchy or runny nose, There is no cure for tree nut allergy. an allergist. sneezing Patients who experience a single mild symptom (e.g., itching, sneezing, hives First, an allergist will do a thorough MOUTH: Itchy mouth and rashes) are often treated with medical history. This will include antihistamines and oral or topical questions to determine if food allergy SKIN: A few hives, mild itch steroids. may be causing your symptoms and to identify the culprit food(s). GUT: Mild nausea or discomfort For severe food allergic reactions, epinephrine is the only medication that Next, the allergist will perform a medical Mild symptoms in more than one body can reverse the symptoms. Medical exam and may conduct tests to help area may be a sign of anaphylaxis and experts advise that people with tree nut identify a food allergy. While these tests requires immediate treatment. allergies always carry two epinephrine alone do not always provide clear-cut auto-injectors with them at all times. answers, the allergist will combine your foodallergy.org © 2020 Food Allergy Research & Education (FARE) TREE NUT ALLERGY

If prescribed, use epinephrine immediately at the first sign of a severe For a Tree-Nut-Free Diet reaction and then call 911. Request Avoid foods that contain nuts or any of these ingredients: an ambulance and tell the dispatchers you are experiencing a suspected food Almond Litchi/lichee/lychee nut Nut pieces Artificial nuts Macadamia nut Pecan allergy or anaphylactic reaction and may Brazil nut Marzipan/almond paste Pesto need additional epinephrine. Patients Beechnut Nangai nut Pili nut should always go to the emergency room Butternut Natural nut extract (e.g., Pine nut (also referred to for further evaluation, even if symptoms Cashew almond, walnut) as Indian, pignoli, pigñolia, Chestnut Nut butters (e.g., cashew pignon, piñon, and pinyon appear to resolve after epinephrine is Chinquapin nut butter) nut) administered. Filbert/hazelnut Nut meal Pistachio Gianduja (a chocolate-nut Nut meat Praline How do I know if a product contains tree mixture) Nut milk (e.g., almond milk, Shea nut Ginkgo nut cashew milk) Walnut nuts? Hickory nut Nut paste (e.g., almond paste)

The federal Food Allergen Labeling Tree nuts are sometimes found in the following: and Consumer Protection Act (FALCPA) Black walnut hull extract Nut distillates/alcoholic Walnut hull extract (flavoring) requires that all packaged food sold in (flavoring) extracts the U.S. disclose when tree nuts are Natural nut extract Nut oils (e.g., walnut oil, an ingredient. This means the package almond oil) label must list the specific tree nut used Keep the following in mind: in the food. ● Mortadella may contain pistachios. ● There is no evidence that coconut oil and shea nut oil/butter are allergenic. Read all product labels carefully before purchasing and consuming any ● Many experts advise patients allergic to tree nuts to avoid peanuts as well. item. Ingredients may change without ● Talk to your doctor if you find other nuts not listed here. warning, so check ingredient statements ● Coconut, the seed of a drupaceous fruit, has typically not been restricted in the diets of carefully every time you shop. If you have people with tree nut allergy. However, in October of 2006, the FDA began identifying coconut as a tree nut. Medical literature documents a small number of allergic reactions to coconut; questions, call the manufacturer. most occurred in people who were not allergic to other tree nuts. Ask your doctor if you need to avoid coconut. Additionally, the use of advisory labeling (e.g., precautionary statements such as “may contain,” “processed products is essential. Always read and includes emergency contact in a facility that also processes,” ingredient labels to identify tree nut information. foodallergy.org/ecp or “made on equipment with”) is ingredients. optional for manufacturers. Because Food Allergy Field Guide - This these statements aren’t required or A person with an allergy to one type of online destination brings regulated, their presence or absence tree nut has a higher chance of being together resources from may or may not indicate if a product allergic to other types. Therefore, many FARE (Food Allergy Research actually contains a specific allergen. experts advise patients with any nut and Education) to help According to the Food and Drug allergy to avoid all tree nuts. Patients newly-diagnosed patients Administration’s guidance to the food may also be advised to avoid peanuts and families navigate their industry on this issue, advisory labels because peanuts have a high likelihood food allergies. It provides you “should not be used as a substitute for of cross-contact with tree nuts during with information you need to adhering to current good manufacturing manufacturing and processing. avoid reactions, shop smartly and practices and must be truthful and not live well with food allergies. misleading.” Additional Resources foodallergy.org/newtofoodallergy

Avoiding Tree Nuts Food Allergy & Anaphylaxis Emergency How to Read a Food Label - Prevent a food Care Plan - This valuable tool outlines allergy reaction by learning how to read To prevent an allergic reaction, strict recommended treatment in case of an a food label for your allergen. avoidance of tree nuts and tree nut allergic reaction, is signed by a physician foodallergy.org/foodlabels foodallergy.org © 2020 Food Allergy Research & Education (FARE)