The Scary Mommy Guide to Tree Nut Allergies in Kids

When it comes to food allergies, most of us — especially when it comes to our kids — take extra precautions around peanuts. Got a bake sale for your daughter’s class? You probably double-check all of the ingredients to avoid legumes. Are you taking a sandwich with your lunch at work? You pack ham and cheese instead of PB&J. And that’s fantastic! But while peanut allergies are often discussed and considered, there’s another common “nut” allergy in town: tree nut allergies.

Of course, peanut and tree nut allergies are different because peanuts aren’t nuts. But we’ll get to that distinction later. For now, we’re going to start with an exploration of what tree nut allergies are, how an adult or child can be diagnosed for them, and, most importantly, what to do in the event of an allergic reaction to tree nuts.

To best paint the big picture, we sought insight from the experts: doctors, dietitians, allergy specialists, even dentists! We ended up with a one-stop shop for all information about tree nut allergies, and we hope the following comprehensive explainer helps lighten your mental load at least a little.

What is a tree nut allergy?

When a person has a food allergy, they have a medical condition in which their immune system creates an abnormal response. This means the immune system launches an attack on proteins in the food that the body would normally find harmless. When this happens, it manifests as an allergic reaction.

A reaction due to a tree nut allergy manifests when the immune system is triggered by the proteins found in tree nuts. The most recognized tree nuts include:

• almonds
• hazelnuts
• pecans
• walnuts
• cashews

There are many lesser-known varieties that families with tree nut allergies will have to learn and be on the lookout for (more on that in a minute).

What are the symptoms of a tree nut allergy?

Janilyn Hutchings, Certified Professional in Food Safety (CP-FS) and StateFoodSafety‘s in-house food safety specialist, emphasized that allergy symptoms can vary by individual but can exhibit as:

• hives around their mouth, face, or torso (if the reaction is more severe, individuals may also get hives on their arms or legs)
• red and itchy skin
• possibly intense itching inside the mouth and throat
• stomach pain
• nausea
• vomiting
• nasal congestion
• difficulty swallowing
• shortness of breath
• diarrhea
• and/or anaphylactic shock

Anaphylaxis is another term for an allergic reaction that can be life-threatening. This is the most serious symptom, which is why exposure to tree nuts should be heavily monitored in kids who haven’t consumed them before.

Kids and adults can have the same symptoms. But, symptoms often vary from person to person. For example, one person with a tree nut allergy may have a life-threatening symptom, while someone else might just suffer from a stomach ache.

Foods to Avoid if You Have a Tree Nut Allergy

Thanks to the Food Allergen Labeling and Consumer Protection Act (FALCPA), U.S. packaged food items are required to clearly state on the label if they contain tree nuts. This stipulates that the specific nut be identified.

Bottom line? Reading labels need to be a mandatory part of your lifestyle from the minute you or someone in your family is diagnosed with a tree nut allergen. You’ll notice some food labels have jargon to the effect of “made in a facility where tree nuts are processed.” Again, whether or not you need to avoid those foods is something to be discussed with an allergist. It’s always better to err on the side of caution, though, and steer clear.

A person with tree nut allergies should clearly avoid foods and products containing tree nuts, as well as items that are presumed to cross-react. It’s confusing; we know.

But in general, the items someone with tree nut allergies should stay away from include but aren’t limited to:

• almonds
• artificial nuts
• beechnut
• Brazil nuts
• butternut
• cashews
• chestnuts
• chinquapin nut
• coconut (deemed a nut by the FDA, but generally determined if safe to consume by a tree nut allergy doctor)
• filberts/cob nuts
• hazelnuts
• gianduja (creamy mix of chocolate and chopped toasted nuts)
• ginkgo nut
• hazelnut spread (like Nutella)
• hickory nuts
• litchi/lichee/lychee nut
• macadamia nuts
• mandelonas (peanuts soaked in almond oil)
• marzipan or almond paste
• mortadella (an Italian sausage made with pistachios)
• nangai nut
• natural nut extract
• nougat
• nut butters
• nut oil/pieces/meal
• nut paste
• pecans
• pesto
• pili nut
• pine nuts/pignolia
• pistachios
• praline
• shea nut
• walnuts
• pure almond extract or wintergreen extract
• some barbecue sauces
• cereals
• some ice creams

If you have any doubts about what’s safe and what isn’t, call your allergist ASAP. They’re the best resource a person with nut allergies has, and they can fill in any blanks for you along the way.

Non-food Items to Avoid

You might understandably presume that you don’t have to worry about tree nuts outside of the kitchen or things that your child consumes. Unfortunately, that isn’t necessarily the case. Per dental hygienist and Toothbrush Life blogger Kelly Hancock, parents of kids with tree nut allergies should take some possible precautions when visiting the dentist.

“Many dentists will place fluoride varnish on the teeth to help protect from cavities. There are certain brands of fluoride varnish that contain resin tree sap material in them, which can cause a reaction in someone with a tree nut allergy,” Hancock explained. “Always disclose your full health history when visiting any medical doctor or dentists so they can take precautionary measures.”

Other non-food related items that may contain tree nuts or tree nut allergens:

• hacky sacks and bean bags
• food for birds as well as domestic rodents (like hamsters and gerbils)

How common are tree nut allergies and what’s the most common one?

In short, much more common than you may think! “Tree nut allergy is one of the most common food allergies seen in any parts of the world,” shared Loveheim. “Its prevalence is reported to be as high as 1 to 2 percent of the population. Studies have shown that 35 percent of those with a peanut allergy may also have a tree nut allergy.”

Hazelnuts, pistachios, cashews, and walnuts are the most common tree nut allergies, but Lovenheim noted walnut is the most reported tree nut allergy, followed by cashew and almond. You might be curious as to why peanuts don’t make the list, and that’s because peanuts are in a completely different category. As briefly mentioned earlier, peanuts grow in the ground — so, they’re technically legumes. That said, peanut allergies are also very common, especially in children.

Those with peanut allergies might also have allergies to tree nuts, so it’s worth testing and making sure if only a peanut allergy is known.

What nuts are not tree nuts?

That peanut news might make you wonder what else doesn’t technically qualify as a “tree nut.”

• Is avocado a tree nut? No. Avocados do grow on trees, but they’re not tree nuts.
• Is olive oil a tree nut? No. Olives are technically a fruit. But, it may be a good idea to check the label hard to make sure that the olive oil you’re using hasn’t been combined with an oil that does include tree nuts, or has been exposed to tree nuts. The best thing to do if you’re highly allergic is to call the manufacturer and double-check to make sure it’s safe.
• Is coconut a tree nut? No. However, some people who have allergies to tree nuts can also develop an allergy to coconut. You should talk to your doctor to figure out whether or not it’s safe to consume.
• Is chocolate a tree nut? No. (Thankfully.) But, this is another food that people with tree nut allergies will want to test. While it’s not a tree nut, many chocolates are manufactured in plants that use the same line with nut products. So, proceed with caution and know what to do in case chocolate starts up a reaction.
• Is cinnamon a tree nut? No. But, having a cinnamon allergy is something that does exist. There are some spices to avoid if one has a nut allergy. Paprika and cumin are the two most likely culprits.
• Is chia seed a tree nut? No. Seeds are plants, not nuts. These should be okay, but consult your doctor if any reaction occurs.
• Can you eat flaxseed with a nut allergy? Yes. Flaxseed should be safe. However, some flaxseed products might come from a plant that also works with tree nuts, so try hard to find flaxseed that comes from a completely nut-free line.
• Is honey safe for nut allergies? Yes. But, honey could be a trigger for people with a soy allergy.
• Is shea butter safe for nut allergies? Likely, yes. Studies are still being done, but most people with nut allergies don’t have a reaction to shea butter.
• Is quinoa safe for nut allergies? Yes. In fact, many people with nut allergies look to quinoa, which is a seed, for protein.
• Is hemp a nut allergy? No. Hemp seeds rarely cause a reaction and aren’t classified as tree nuts (or peanuts.)
• Can I drink nut milk if I’m allergic to nuts? No. You’ll want to stay away from all products that contain nuts. If you’re trying to add them back into your diet, it’s best to consult with an allergist or doctor beforehand.

Can you be allergic to some tree nuts and not others?

Yes! Some people with tree nut allergies must strictly avoid all tree nuts. Other people can partake of certain tree nuts but not others. That’s a call you’ll have to make with your doctor or allergy specialist.

Adrienne Urban, food allergy/special diet blogger at Whole New Mom, learned after her son was diagnosed with tree nut allergies that although his reaction to most tree nuts is extreme, it isn’t across the board. “Yes, this can happen. In fact, this is the case with our son,” she shared with Scary Mommy. “He is deathly allergic to all tree nuts except for almonds and macadamias.” So to ensure her son’s safety, Urban purchases nuts for her family from suppliers without cross-contamination. “It takes a little homework, but it’s worth the peace of mind!” she said.

Having said that, Dr. Tania Elliott, allergist and spokesperson for the American College of Allergy, Asthma and Immunology (ACAAI), pointed out to Scary Mommy, “There is a high degree of cross-reactivity among tree nuts, which is why allergists often recommend avoiding them altogether.”

What is the difference between a tree nut allergy and a peanut allergy?

An allergic reaction to any food is the same at the core — an abnormal immune system response. However, a tree nut allergy is a true “nut” allergy, whereas a peanut allergy is not. This doesn’t mean that one is better or worse than the other (they all suck!). It simply means that peanuts aren’t actually nuts; they’re legumes. Interestingly, between 25 to 40 percent of people allergic to peanuts also react to at least one nut, according to the ACAAI.

Tree Nut Allergies in Kids

Most babies aren’t exposed to tree nuts very early in life and severe reactions from ingesting breast milk (after a mother has eaten tree nuts) aren’t common. Kids also exhibit many of the same symptoms as adults do, the difference being, of course, that they can’t convey their distress the same way an adult can. When a child is old enough to talk, said Hutchings, what they say may clue you into a potential tree nut allergy.

According to Hutchings, this might sound like:

• “My tongue is hot, itchy, or heavy”
• “There are bumps or hair on my tongue”
• “My throat feels thick”
• “My lips or throat feel tight”
• “There’s something stuck in my throat”
• “My mouth feels funny”
• “My ears feel itchy.”

How long does a tree nut allergy reaction take to develop?

A tree nut allergic reaction may be immediate, but it could also be delayed and present hours after ingestion. “A tree nut allergic reaction is typically what is called an IgE mediated reaction and involves the release of a product in your body called histamine. This release causes most of the symptoms often associated with an ‘allergic reaction,'” Dr. Jay Lovenheim, D.O., F.A.A.P., of Lovenheim Pediatrics, told Scary Mommy.

Also good to know? Even after it seems as though your child’s reaction has subsided, a second wave of symptoms may strike one to several hours later.

Can you take anything for tree nut allergies?

In the case of a severe reaction — so, if anaphylaxis is suspected — you’ll have to administer your or your child’s epi-pen. Unfortunately, it’s simply not safe to make judgment calls about using over-the-counter medications or seeking alternative treatment once a person with a tree nut allergy shows signs of a reaction.

“We do not recommend antihistamines such as Benadryl as first-line treatment for food allergy. It will only help skin symptoms, and it will not prevent a reaction from progressing,” explained Elliott. “Steroids take hours to kick in and should not be administered in the setting of an acute reaction.”

How do you test for a tree nut allergy?

“Tree nut allergy is usually diagnosed based on a history of reactions after eating a tree nut, and may be confirmed using a blood test or a skin test called a prick test,” said Lovenheim. “Due to the higher than preferred rates of false-positive results from blood tests and prick tests, physicians will not make the diagnosis based on the test results alone. A history of a reaction after ingestion is usually required. If no such reaction is noted by the family, then a patient is often asked to ingest a small amount of tree nut under the supervision of an allergist. This is called an oral food challenge.”

This sort of food challenge should always be performed in a proper medical setting and never attempted at home.

Are tree nut allergies genetic?

Yes and no. “If one parent has a history of allergies, there is a 50 percent chance of their children having allergies. If both parents are allergic, there is a 75 percent chance of their children being allergic,” said Dr. Jacqueline Jones, ear, nose, and throat specialist and author of Medical Parenting: How to Navigate Health, Wellness & The Medical System with Your Child. That’s the “yes.”

Now for the “no.” Elliott underscores that the above statistic speaks to allergies in general, not tree-nut-specific allergies. “While allergies tend to run in families, it is impossible to predict whether a child will inherit a food allergy,” she said.

Can you prevent tree nut allergies from developing?

Per Jones, “There is currently no cure for food allergies, nor are there medications to prevent reactions.” Having said that, studies suggest that being proactive in your child’s early stages could make a difference.

“If your infant is at risk for developing a food allergy — for example, if they have family members with allergies or severe eczema — it has been proven that if you introduce tree nuts before six months of age, the risk of developing a tree nut allergy is greatly decreased,” Allie Gregg, a registered dietitian with a practice in Kansas City, Missouri, shared with Scary Mommy. She continued, “There are several baby food brands that are available specifically for introducing high allergen foods early to babies. A few of the brands include My Peanut, SpoonfulOne, and Inspired Start.”

And not to beat the same old drum here, but by now it goes without saying that you should always consult your child’s pediatrician and/or allergist before making any big dietary decisions for your food-nut-sensitive child.

Do tree nut allergies ever go away?

Well, it isn’t entirely outside of the realm of possibility. According to Jones, approximately 10 percent of children with tree nut allergies may outgrow them over time. Common sense mandates that children with significant tree nut allergies should undergo allergy testing with a specialist prior to re-introducing any tree nuts into their diet. However, it’s more likely that a tree nut allergy will follow a child into adulthood.

Still, there are things you can (and should) do to manage the condition. “The most important of these is avoiding coming into contact with food proteins that cause an allergic reaction,” advised Jones. “Read food labels to ensure that you don’t eat foods that contain [tree nuts]. Always ask about ingredients when eating at restaurants or when you are eating foods prepared by family or friends. Be sure to have an Anaphylaxis Action Plan and carry your epinephrine auto-injector with you at all times.”