General Information

  • Reactions to food are common and can be divided into two categories, those caused by food allergy and all other reactions
  • Food allergies develop when the body’s immune system has an abnormal reaction to one or more proteins in a food that can lead to serious allergic reactions
  • Other food reactions are not caused by the immune system but can cause unpleasant symptoms (examples include lactose intolerance, heartburn, food poisoning, and sensitivities)
  • Tree nut allergy is one of the most common food allergies
  • People with an allergy to one tree nut have a greater chance of being allergic to other types of tree nuts
  • Coconut, water chestnuts and nutmeg are NOT tree nuts
  • Tree nuts grow on tress and are different from peanuts (peanuts are in the legume family) - Around 30% of people with a tree nut allergy are also peanut allergic

Tree Nut Avoidance

  • Tell anyone with regular contact with you or your child about the allergy and avoidance of tree nuts
  • Read labels every time you buy something. Manufacturers can change products at any time - Be aware of cross contamination (transfer of tree nuts to a food that does not normally have tree nuts as an ingredient)
  • Common tree nuts include:
    • Almond
    • Chinquapin nut
    • Nangai nut
    • Pine nut
    • Beechnut
    • Hazelnut / filbert
    • Macadamia nut
    • Pistachio
    • Brazil nut
    • Hickory nut
    • Pecan
    • Shea nut
    • Cashew
    • Ginkgo nut
    • Pili nut
    • Walnut
    • Chestnut
  • Some foods that contain or may contain tree nut protein
    • Artificial nuts
    • Flavored coffee
    • Nut substitutes
    • Araretto (almond)
    • Flavored liqueurs
    • Natural flavors and extracts
    • Baked goods (cake, cookies)
    • Gianduja / giandula
    • Pastries / pies
    • Barbecue sauce
    • Glazes
    • Pesto
    • Candy
    • Granola bars
    • Pralines
    • Calisson (almond)
    • Hazelnut paste
    • Salads
    • Cereals / muesli
    • Ice cream / frozen yogurt
    • Salad dressing
    • Chocolate / Candy bars
    • Icing
    • Satay
    • Chilli
    • Marzipan (almond)
    • Sundae toppings
    • Crackers
    • Nougat
    • Smoke flavor (BBQ sauce)
    • Energy bars
    • Nut butters (almond, cashew)
    • Trail mix
    • Frangelico (hazelnut)
    • Nutella
    • Tree nut oil

Allergic Reactions

  • Symptoms often occur within minutes up to 2 hours of exposure to tree nuts:
  • Outside Symptoms
    • Face: Redness, itchy eyes / nose, swelling
    • Skin: Itching, redness, hives, swelling
  • Inside Symptoms
    • Face: Swelling lips and tongue, itchy mouth
    • Throat: Itching, tightness, hoarse voice, cough
    • Lungs: Trouble breathing, shortness of breath
    • Stomach: Vomiting, nausea, stomach pain, diarrhea
    • General: Dizzy, unsteady, drowsy, fainting
  • Not every reaction will look the same, a person can have different symptoms each time
  • Symptoms range from mild to life threatening, there is no way to predict if the reaction will be mild or severe
  • Anaphylaxis is a severe life threatening reaction with more than one body system affected (skin, breathing, stomach, general) and can occur WITHOUT skin symptoms such as hives

Treatment of Reactions

  • Antihistamines such as Benadryl will NOT stop severe reactions
  • An epinephrine auto injector such as Allerject or EpiPen MUST be available at all times
  • If you are visiting an area without access to a hospital you should have 2 auto injectors available
  • A medical identification device such a Medical Alert bracelet should be worn to outline the food allergy and that an epinephrine auto injector is carried
  • Give epinephrine in the outer thigh if there are any of the following symptoms (listed in the table on the previous page)
    • General symptoms
    • Severe outside symptoms
    • Any inside symptoms
    • If you are in doubt, give the epinephrine
  • After epinephrine is given
    • Lie down / lie your child down
    • Call local emergency service and tell them someone is having an allergic reaction
    • If the reaction continues or worsens, give a second dose of epinephrine in 5 - 15 minutes (there is only 1 dose of epinephrine in each auto injector, a second dose requires a new auto-injector)
    • Go to the nearest emergency room even if the symptoms are gone because the reaction can worsen or come back
    • Stay in the hospital for at least 4 - 6 hours of observation

Outcomes for Tree Nut Allergic Patients

  • Around 10% of people will outgrow the tree nut allergy
  • Repeat skin testing and blood work every 1 - 2 years will help determine if the allergy is outgrown
  • An oral food challenge (eating tree nut products in small steps ONLY in the doctors office) will be offered if your doctor feels it is safe
  • Tree nut products should NEVER be tried outside of a doctors office to see if the allergy is outgrown

Additional information: www.anaphylaxis.ca or www.foodallergy.org