Featured Image for Food Allergy Basics - Part 2: The Usual Suspects - Tree Nuts

Our first article in this series, Food Allergy Basics – Part 1: What You Need to Know introduces you to food allergies by explaining how the medical community identifies and separates a true food allergy from other reactions. True food allergies are marked by the response of a specific antibody, known as Immunoglobulin E (IgE), to specific food proteins. What can be accurately inferred from this is that if a food contains protein, a person can have an IgE-mediated allergic reaction to that food.

According to the Food and Drug Administration (FDA), there are currently more than 160 identified foods which cause IgE-mediated allergic reactions. Commonly referred to as The Big Eight, or in this case The Usual Suspects, peanuts, tree nuts, milk, eggs, wheat, soy, fish and shellfish account for 90 percent of all allergic food reactions.

Part two of this series is broken down into eight installments to provide an adequate profile for each of the eight major food allergens. The first installment of Food Allergy Basics – Part Two: The Usual Suspects offered an overview of peanut allergies and products to be avoided should you have an allergy to peanuts. This installment will examine tree-nut allergies.

Tree Nuts

Tree nuts are one of the major allergens most commonly associated with a high risk of anaphylaxis. They are also one of the most common food allergens in children and adults. According to Food Allergy Research & Education (FARE), only about 9 percent of children outgrow the allergy.

Tree nut is a rather broad category of tree-grown, edible kernels housed within a hard shell.  Despite all tree nuts being lumped into the same allergen category, most people with tree nut allergies are not allergic to all nuts. However, being allergic to one type of tree nut can increase your risk of being allergic to other tree nuts. In the US, walnuts, cashews and almonds are the three most common tree-nut allergens and each shares similarities with certain other tree nuts, increasing the risk of having an allergic reaction with those nuts.  It is for this reason that people with an allergy to one tree nut are advised to avoid all tree nuts.

Though peanuts are a legume and are an allergen category of their own, people with tree-nut allergies are warned to avoid peanuts as well. This extra precaution is advisable because peanuts and tree nuts are often processed using the same equipment and it only takes a very small amount of the allergen to elicit a reaction.

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Coconuts are another ambiguous item in the tree-nut allergy category. Though botanically they are considered a fruit and coconut allergy is fairly rare, they share allergenic properties with hazelnuts and walnuts. As a precaution, and for the purposes of labeling, the Food and Drug Administration (FDA) considers coconuts to be a tree nut and therefore must be disclosed as a potential allergen on ingredient labels.

What to Avoid

Because it is a broad category, there is a rather long list of foods to avoid if you have or suspect you have a tree-nut allergy. Some of these foods may be quite obvious, others less so:

·         Almond

·         Artificial nuts

·         Brazil nut

·         Beechnut

·         Butternut

·         Cashew

·         Chestnut

·         Chinquapin nut

·         Coconut

·         Filbert or hazelnut

·         Gianduja (a chocolate nut mixture such as Nutella®)

·         Ginkgo nut/seed

·         Hickory nut

·         Litchi nut (also spelled lichee or lychee)

·         Macadamia nut

·         Nangai nut

·         Nut butters

·         Nut meal

·         Nut meat

·         Nut paste, including marzipan or almond paste

·         Nut pieces

·         Pecan

·         Pesto

·         Pili nut

·         Pine nut (also known as Indian, pignoli, pigñolia, pignon, piñon, and pinyon nut)

·         Pistachio

·         Praline

·         Shea nut

·         Walnut

Tree nuts and tree-nut proteins can often be found in many snacks, cereals, baked goods, frozen desserts, candies including chocolates, and energy bars. There are also several unexpected or unrecognized sources for tree nuts such as flavored coffee, marinades and barbeque sauces, and some cold cuts. Certain bath and body products such as lotions and soaps are made with tree nut oils which contain nut proteins and should be avoided.

Natural nut extracts including walnut or black walnut hull extract, nut distillates or alcoholic extracts, and natural wintergreen extract, because it could contain hazelnut, should also be avoided. Imitation or artificial extracts are generally considered safe for people with tree-nut allergies. Some alcoholic beverages should be avoided because they may contain natural nut flavorings or extracts. Alcohol is not currently required to adhere to the same labeling requirements as food is, so the presence of nut extracts may not be stated on the label.

Establishments where nuts are commonly used as an ingredient are considered to be high-risk for people with tree-nut allergies. These establishments include, but are not limited to ethnic food restaurants such as Chinese, African, Indian, Thai and Vietnamese restaurants, as well as ice cream parlors and bakeries. Even items ordered without nuts may not be safe, as they are at an increased risk of cross-contact with tree nuts in these establishments.

If you have any doubt at all as to the presence of tree nuts in the product you are considering, carefully reading labels and inquiring about the ingredients in your food and other products you come into contact with are vitally important to avoiding potential exposure.