When Your Child Has a Food Allergy: Tree Nut
When a child has a tree nut allergy, exposure to even small amounts of tree nuts can cause a life-threatening reaction. For that reason, your child must stay away from tree nuts and any foods that contain them. This sheet tells you more about your child’s tree nut allergy. You’ll learn what foods your child should stay away from, what to look for on food labels, and how to prevent cross contact. Cross contact means that tree nuts accidentally come in contact with foods your child can safely eat.
Foods to stay away from
All true nuts such as almonds and walnuts grow on trees. Peanuts are a legume and grow underground. Yet many children who are allergic to tree nuts are also allergic to peanuts. Ask your child’s healthcare provider whether peanuts are safe for your child. Children with tree nut allergies should stay away from all of the following:
Filberts (also known as hazelnuts or cob nuts)
Pine nuts (also called piñon nuts, pignolias, pignon nuts, pignolia nuts, Indian nuts)
Any desserts that contain nuts, including cakes, candy, cookies, and pies
Artificial nuts that contain nut flavoring
Some barbecue sauces
Some chocolate candies. These may have had contact with nuts.
Cold-pressed, expeller-pressed, or virgin nut oils. Ask your child’s healthcare provider if refined nut oils are safe.
Energy, health, and breakfast bars that contain nuts
Fish and chicken crusted with nuts
Natural and artificial flavorings
Granolas, muesli, and other fruit-and-nut breakfast cereals
Mangos. These are related to cashews and may not be safe for your child.
Mortadella. This is an Italian smoked sausage often made with pistachios.
Nut butters, such as almond and cashew butter
Pesto. It is an Italian sauce that usually contains nuts.
Shelled pumpkin seeds and sunflower seeds. These may be processed on the same equipment as nuts.
Specialty cheese spreads
Sweets, such as almond paste, marzipan, nougat, and gianduja
Note: Talk with your child's healthcare provider about the need to stay away from peanuts.
What to look for on labels
Foods your child can safely eat may come in contact with nuts during processing. This happens most often with cookies, candy, ice cream, and dried soup mixes. Some children are more sensitive to tree nuts than others. Ask your child's healthcare provider about foods that carry these warnings:
May contain traces of nuts.
Made in a factory that processes peanuts and tree nuts.
Produced on equipment shared with tree nuts.
Always use caution with imported foods, especially chocolates. They may contain allergens not listed on the label.
Nonfood allergens to watch for
Many nonfood products contain tree nuts or tree nut oils. These include:
Hacky Sacks and beanbags
Hamster, gerbil, and bird food
Suntan lotions, shampoos, soaps, bath oils, body oils, and skin creams. If you’re not sure about a product, visit the product maker’s website or call the toll-free number on the package.
Preventing accidental exposure
Foods your child can safely eat may come in contact with tree nuts at home, at school, and in restaurants. To help prevent accidental exposure:
Teach your child not to eat snacks that are given outside the home. Your child should also not sample free cookies and other snacks in stores or buy candy from vending machines.
Don’t grind nuts in a grinder you use for other foods. If you chop nuts, thoroughly wash cutting boards and knives before using them again.
Don't use the same scoop for different ice creams.
Explain your child’s allergy to your child’s teacher and other parents.
Talk to your child’s school about having a nut-free table in the cafeteria.
Send nut-free treats to school and to parties and outings.
Be careful around salad bars and buffets, especially in Asian restaurants.
Carry a “chef card” that explains your child’s allergy to restaurant workers. You can make your own card or print one from a website on the Internet.
If your child has ANY of the symptoms listed below, act quickly!
If one has been prescribed, use an epinephrine autoinjector right away. Then call 911 or emergency services.
Trouble breathing or cough that won’t stop
Swelling of the face and mouth
Vomiting or severe diarrhea
Dizziness or fainting
There are many areas of ongoing research that focus on understanding allergies and allergic reaction. Please check with your child's healthcare provider about new research findings that may help your child.
February 08, 2018
Guidelines for the Diagnosis and Management of Food Allergy in the United States. Boyce J. The Journal of Allergy and Clinical Immunology. 2010;126(6):s1-s58.
Bass, Pat F. III, MD, MPH,Blaivas, Allen J., DO,Image reviewed by StayWell art team.,Pierce-Smith, Daphne, RN, MSN, CCRC