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Nut allergy is one of the most common food allergies in children.

Nuts can cause a severe, potentially fatal, allergic reaction (anaphylaxis). It is therefore recommended that anyone with a nut allergy have immediate access to injectable epinephrine at all times and know how to use it.

To avoid an allergic reaction, strict avoidance of nuts and their derivatives is essential. Always read product labels for nut identification.

Nut allergy can be lifelong, although about 9% of children will eventually outgrow their allergy.

Younger siblings of children with a nut allergy appear to be at increased risk of developing a nut allergy. Therefore, allergy testing is recommended for these children.

Nuts include, but are not limited to, walnuts, almonds, hazelnuts, cashews, and pistachios. They should not be confused or lumped together with peanuts, which are legumes, or with seeds such as sunflower or sesame seeds.

Anyone who is allergic to one type of nut is more likely to be allergic to other types. Although it is common to avoid all nuts, including peanuts, in children with nut allergies, each case should be individualized.

Avoiding Nuts

Read all food labels before purchasing and consuming them. The contents of prepared food products may change without notice. If you have any questions, contact the manufacturer.

The use of phrases such as ‘may contain…’ on prepared food products is not clear and it is usually recommended to avoid such foods.

Avoid foods containing nuts or any of the following ingredients

• Almond
• Marzipan
• Nut butters (e.g. cashew)
• Nut milks (e.g. almond milk, cashew milk)
• Olive oil
• Nut pastes (e.g. almond paste)
• Macadamia ternifolia fruit
• Coconut*
• Walnut
• Cashew
• Chestnut
• Pine nut
• Praline
• Sauce pesto
• Artificial nuts
• Hazelnut
• Natural nut extract (e.g. walnut, almond)
• Pistachio

* Coconut, although often recognized as a nut, is classified as a fruit. Although coconut allergy has been reported, most people with nut reactions can safely eat coconut. Consult your doctor if you are allergic to nuts before consuming coconut.

Nuts can sometimes be found in the following:

• Nut Distillates
• Nut Oils
• Walnut Shell Extract
• Natural Nut Extracts

Some Unexpected Sources of Nuts**

• Nut protein can be found in cereals, sweets, cookies, chocolates, energy bars, flavored coffees, frozen desserts, marinades, barbecue sauces, and some meat meals e.g. mortadella.
• Some alcoholic beverages may contain nut flavoring and should be avoided. are avoided.

**Caution: This list cites examples where peanuts have been found unexpectedly. The list is not intended to imply that nuts are always present in these foods, but rather to serve as a reminder to read labels and ask questions before consuming food that we have not prepared ourselves.

Remember:

• The following are common nuts, where the risk of an allergic reaction is unknown (they usually come from abroad and should be looked for on foreign-origin labels: ‘beechnut, sheanut, butternut, hickory, chinquapin, lycheenut, pilinut’).
• Nut oils may contain nut protein and should be avoided. Nut oils are sometimes used in lotions, hair care products, and soaps.
• Ethnic restaurants (e.g., Chinese, African, Indian, Taiwanese, Vietnamese), ice cream parlors, and bakeries are considered high-risk for people with nut allergies, even if you order a nut-free product.
• Avoid natural nut extracts. Imitation or artificial extracts are generally safe.
• Pink peppercorn allergy may be possible in people with cashew allergies. This dried berry (Scinus) is used as a spice, but is different from the standard black pepper.