Tree Nut Allergy

An estimated 1.8 million Americans have an allergy to tree nuts. Allergic reactions to tree nuts are among the leading causes of fatal and near-fatal reactions to foods. Tree nuts include, but are not limited to, walnut, almond, hazelnut, cashew, pistachio, and Brazil nuts. These are not to be confused or grouped together with peanut, which is a legume, or seeds, such as sunflower or sesame.

Like those with peanut allergies, most individuals who are diagnosed with an allergy to tree nuts tend to have a lifelong allergy. As you’ll see below, tree nuts can be found as ingredients in many unexpected places.

Some Unexpected Sources of Tree Nuts
Salads and salad dressing
Barbecue sauce
Breading for chicken
Pancakes
Meat-free burgers
Pasta
Honey
Fish dishes
Pie crust
Mandelonas (peanuts soaked in almond flavoring)
Mortadella (may contain pistachios)

*Note:  This list highlights examples of where tree nuts have been unexpectedly found (i.e., on a food label for a specific product, in a restaurant meal, in creative cookery, etc.) This list does not imply that tree nuts are always present in these foods; it is intended to serve as a reminder to always read the label and ask questions about ingredients before eating a food that you have not prepared yourself.

Keep in Mind
Many experts advise patients allergic to tree nuts to avoid peanuts and other tree nuts because of the high likelihood of cross-contact at processing facilities, which process peanuts and different tree nuts on the same equipment. Further, a person with an allergy to one type of tree nut has a higher chance of being allergic to other types. Discuss with your doctor whether to avoid other tree nuts.

Tree nuts may be found in a wide range of unexpected foods for flavor or consistency. If ingredient information is not provided for a particular food or you question its accuracy, avoid the food completely.
Younger siblings of children allergic to tree nuts may be at increased risk for allergy to tree nuts. Your doctor can provide guidance about testing for siblings.

Tree nuts can cause severe allergic reactions. If your doctor has prescribed epinephrine, be sure to always carry it with you. Learn more about anaphylaxis.

Most experts advise patients who have been diagnosed with an allergy to specific tree nuts to avoid all tree nuts.

Commonly Asked Questions

Should coconut be avoided by someone with a tree nut allergy?
Discuss this with your doctor. Coconut, the seed of a drupaceous fruit, has typically not been restricted in the diets of people with tree nut allergy. However, in October of 2006, the FDA began identifying coconut as a tree nut. The available medical literature contains documentation of a small number of allergic reactions to coconut; most occurred in people who were not allergic to other tree nuts. Ask your doctor if you need to avoid coconut.

Is nutmeg safe?
Nutmeg is obtained from the seeds of the tropical tree species Myristica fragrans. It is generally safe for an individual with a tree nut allergy.

Should water chestnuts be avoided?
The water chestnut is not a nut; it is an edible portion of a plant root known as a "corm." It is safe for someone who is allergic to tree nuts.

The Food Allergy and Anaphylaxis Network