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Navigating Allergies and Food Sensitivities

Nut Allergies

Nut Allergy Info

Tree nut allergy is one of the most common types of food allergy. This allergy is one of the leading causes of fatal and near fatal food-allergic reactions, and tends to be life-long; recent studies have shown that only about 9% of children outgrow their tree nut allergy.1

A tree nut allergy is distinct from a peanut allergy. Peanuts are considered legumes (e.g., peas, beans, lentils), whereas a nut is a hard shelled fruit of certain plants. A person with peanut allergies may not necessarily also be allergic to tree nuts, and vice versa.1

BUT, the proteins in peanuts are similar in structure to those in tree nuts. For this reason, people who are allergic to peanuts can also be allergic to tree nuts. There is a 30 to 60% chance of a child with a peanut allergy to develop a tree nut allergy.2

nut free

Tree nuts include:

  • Almonds
  • Brazil nuts
  • Cashews
  • Chestnuts
  • Filberts
  • Hazelnuts
  • Macadamia nuts
  • Pecans
  • Pine nuts (pignolia nuts)
  • Pistachios
  • Walnuts

People with a tree nut allergy are seldom allergic to just one type of nut, and are therefore usually advised to avoid all tree nuts.1

If you suffer from a nut allergy, strictly avoiding nuts, both peanuts and tree nuts, and food containing nuts is the only way to prevent a reaction. But, it is not always easy to avoid these foods since many unsuspecting products contain nuts.3

Always check the label ingredients before you use a product. Also, keep in mind that many prepared foods, including baked goods, candy, and ethnic foods, can be contaminated with peanuts if products containing peanuts are prepared in the same place or by the same manufacturer. Always be prepared for this possibility and the risk of a reaction.

Table 1 lists examples of tree-nut products, and foods that may contain them:3


Table 1: Tree-nut products and foods that may contain them3
Tree Nuts Tree Nut-Containing Ingredients Nut-Containing Foods
AlmondsBrazil nuts





Hickory nuts

Macadamia nuts


Pine nuts



Marzipan / almond pasteNougat

Artificial nuts

Nut butters
(such as cashew butter and almond butter)

Nut oil

Nut paste
(such as almond paste)

Nut extracts
(such as almond extract)

Ground nutsMixed nuts

Chex mix®

Artificial nuts


African, Chinese, Thai,
and other ethnic dishes

Cookies, candy, pastries,
and other baked goods

Grain breads

Ice cream, frozen desserts

High-energy bars

Cereals and granola

Salad dressing



Tree nuts are sometimes used in lotions, suntan lotions and shampoos. Be sure to check labels of these products.

Note: ATROVENT® (ipratropium bromide) Inhalation Aerosol and COMBIVENT® Inhalation Aerosol should not be used in patients who:

If a person is allergic to peanuts or tree nuts, there is a good chance he or she is allergic to sesame as well.5,6  In a study presented at the annual meeting of the American Academy of Asthma, 70% of the patients allergic to sesame were also allergic to tree nuts, while 65%  of patients allergic to sesame were allergic to peanuts.5 In a separate study, Boston researchers at Children’s Hospital Boston found that kids who have had allergic reactions to tree nuts are nearly three times more likely to have allergic reactions to sesame seeds.7



National Institutes of Health, NIAID Allergy Statistics

The Journal of Allergy and Clinical Immunology, May 12, 2010

Food Allergy – Quick Facts.


Scott H. Sicherer, Anne Muñoz-Furlong, James H. Godbold, Hugh A. Sampson.

US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up.

DOI: 10.1016/j.jaci.2010.03.029.


Boehringer Ingelheim Pharmaceuticals Press Release.

FDA maintains essential use status of Combivent®.


Sesame Seed Allergy.


Stutius LM et al.

AAAA&I, Washington, DC, March 2009.

Characterizing the Relationship Between Peanut and Sesame Allergy in Children.