Tree Nut Allergy: What to Eat and What to Avoid

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Tree nut allergies 101 – everything you need to know to stay safe. Includes peanut vs tree nut allergies, a list of symptoms for tree nut allergies, and what you need to know to avoid tree nut allergy reactions. 

The tree nut allergy is one of the most common allergies in children, with upwards of 1% of all peoples in the United States allergic to tree nuts, which is about 3 million! 

If you are allergic to one tree nut, you may not be allergic to all of them, but I have found that many times people have a cross reaction to many tree nuts. 

The nuts of the Tree Nut allergy include: almonds, brazil nuts, cashews, coconut, hazelnuts, pecans, pistachios, and walnuts. 

Tree nut allergies are one of the most severe allergies to have, with anaphylactic reactions common. If your child has suddenly developed a tree nut allergy, you do want to stress to them teh importance of being safe and how something might be changing, but it is to keep them healthy. 

This article walks you though all aspects of a tree nut allergy, symptoms, waht to avoid, what you can still enjoy, and how best to manage your tree nut allergy. 

a variety of nuts are shown in glass jars. a search bar with questions about tree nut allergies is also seen

What is a tree nut allergy? 

Tree nut allergies are one of the most common allergies in the world, making it included in the top 9 allergens. It is general an allergy that is not outgrown as you age. If you become allergic to tree nuts as an adult, you will probably have this for the rest of your life. 

An allergy occurs when the body is exposed to a tree nut protein and develops a strong IgE antibody response. This is the body’s own antibodies working to protect itself from something it views as a threat, in this case a tree nut protein. 

The body responds by triggering the immune system that causes different effects on the body (see symptom list below) that can range from mild to life-threatening. 

Tree nuts and other nuts and seeds 

Tree nuts are different from Peanuts, though about 25 to 40% of people who are allergic to peanuts are also allergic to tree nuts. This similar protein structure causes something known as cross-reactivity. Currently, the FDA also classifies a Coconut as a tree nut, despite them being a fruit and not a nut or seed. For more information, you can read my article all on the Peanut Allergy and the Coconut Allergy.

People who are allergic to tree nuts can usually eat seeds without worry of an allergy, such as sesame, sunflower, and pumpkin.

Macadamia nuts and Pine nuts are not actually nuts at all, but also seeds, and so the majority of tree nut allergic people can eat them. However, you should always use caution when eating them and chat with your doctor if you are unsure.

Symptoms of a tree nut allergy 

Most children and adults will develop an allergic reaction either immediately, a few minutes, or as long as a few hours after consuming a tree nut. Remember, some people are so allergic to certain foods that even touching or smelling the food can cause a reaction. 

A list of possible reactions includes:

  • Swelling, itching, or irritation of the mouth, lips, tongue, or throat
  • Asthma attack
  • Eczema on the skin
  • Hives, itching rash on the skin
  • Nasal congestion
  • Headaches
  • Difficulty breathing
  • Cramping and/or pain of the stomach or bowels
  • Nausea
  • Vomiting
  • Diarrhea
  • Anaphylactic reactions (see below) 
a list of symptoms of a tree nut allergy are shown next to a half circle of mixed nuts

Anaphylactic reaction to tree nuts

For some people, a life threatening reaction known as an anaphylactic reaction may occur after consuming, touching, or smelling tree nuts or tree nut by-products. If this happens, please call 911 or your local emergency number immediately. Signs and symptoms of this include:

  • Swelling or tightening of the throat
  • Difficulty breathing
  • Chest pain or tightness
  • Trouble swallowing
  • Dizziness or fainting
  • Change of normal coloring of the skin in the mucous membranes (inner lips, gums, around the eyes, and nail beds) 
    • Light skin, check for signs of dark blue tints in the mucous membranes 
    • Medium skin, check for signs of a gray-green tint in the mucous membranes
    • Dark skin, check for signs of gray or white tint in the mucous membranes  

Tree nut allergy safety in school and work

If your child has a tree nut allergy, make sure to let both the school and their individual teachers know of their allergy. Any medication they might need, including an EpiPen if the reaction is severe, needs to be kept at the school in case of emergencies.

In elementary school, when they have assigned seating, it is easier to maintain a clean workspace for your child. As they go through middle and high school and beyond, make sure to have them wipe down the desk before they use it as there could be oils on the desk after someone ate a granola bar, for example.

The most dangerous moments for your child will be during school parties when parents bring in sweet treats to celebrate. You must teach your child that they can’t participate in these events no matter how good the cupcake (or whatever the treat is) looks because we don’t know if it’s safe.

Another dangerous moment is at the lunch table. While you might pack a safe lunch for your kid, there is no guarantee that they don’t swap foods to share with friends at the table. This is another thing you need to teach your kids not to do.

In a work environment, you should inform your coworkers of your allergy and ask them to not eat tree nuts around you or your workspace, especially if your allergy is severe and anaphylactic. Making sure to wipe down surfaces is again important.

a bowl filled with mixed nuts is shown next to text talking about tree nut allergies

how to read a food label with a tree nut allergy

Learning how to read food labels is one of the most important things you can do after developing a tree nut allergy. Always make sure that you read the entire label and not just quickly scan for tree nuts as ingredients can hide under different names.

Sometimes companies will place advisory statements on their label to say things such as, “May Contain” or “Produced in the same facility as…”. These are not required by law but are placed there at the discretion of the company. Talk with your doctor about whether you should avoid these food labels as well.

In general, I tend to avoid any and all food products that list my own allergies on these advisory statements. You never know if one day cleaning the machines, an allergen was totally washed away or not. I err on the side of caution with my health and suggest you do the same.

want to know the best things to swap for different recipes? make sure you check out my food swap guide

What to Avoid with a Tree Nut Allergy

When looking at a food label, make sure that the ingredient list does not contain any of the following items. The list of foods to avoid is long, and while I’ve done my best to include them all here, I am sure there are more being made and discovered each day. If you know of an allergy name that I’ve missed, write it in the comments below and I’ll be sure to add it to the list!

Tree Nut Names

  • Almond
  • Beechnut
  • Brazil nut
  • Bush nut
  • Butternut
  • Cashew
  • Chestnut
  • Coconut
  • Filbert
  • Ginko nut
  • Hazelnut
  • Hickory nut
  • Lichee nut
  • Macadamia nut
  • Nangai nut
  • Pecan
  • Pine nut
  • Pistachio
  • Shea nut
  • Walnut

Tree Nuts also have a few variances on their names. You need to also watch out for:

  • Almond
  • Almond paste
  • Anacardium nuts
  • Anacardium occidentale (Anacardiaceae) [botanical name, Cashew]
  • Artificial nuts
  • Beech nut
  • Brazil nut
  • Bertholletia excelsa (Lecythidaceae) [botanical name, Brazil nut]
  • Bush nut
  • Butternut
  • Butyrospermum Parkii [botanical name, Shea nut]
  • Canarium ovatum Engl. in A. DC. (Burseraceae) [botanical name, Pili nut]
  • Caponata
  • Carya illinoensis (Juglandaceae) [botanical name, Pecan]
  • Carya spp. (Juglandaceae) [botanical name, Hickory nut]
  • Cashew
  • Castanea pumila (Fagaceae) [botanical name, Chinquapin]
  • Castanea spp. (Fagaceae) [botanical name, Chestnut (Chinese, American, European, Seguin)]
  • Chestnut (Chinese, American, European, Seguin)
  • Chinquapin
  • Coconut
  • Cocos nucifera L. (Arecaceae (alt. Palmae)) [botanical name, Coconut]
  • Corylus spp. (Betulaceae) [botanical name, Filbert/hazelnut]
  • Filbert
  • Fagus spp. (Fagaceae) [botanical name, beech nut]
  • Gianduja
  • Ginko nut
  • Ginkgo biloba L. (Ginkgoaceae) [botanical name, Ginko nut]
  • Hazelnut
  • Heartnut
  • Hickory nut
  • Indian nut
  • Juglans cinerea (Juglandaceae) [botanical name, Butternut]
  • Juglans spp. (Juglandaceae) [botanical name, Walnut, Butternut, Heartnut]
  • Karite (shea nut)
  • Lichee nut
  • Litchi chinensis Sonn. Sapindaceae [botanical name, Lichee nut]
  • Lychee nut
  • Macadamia nut
  • Macadamia spp. (Proteaceae) [botanical name, Macadamia nut/Bush nut]
  • Mandelonas
  • Marzipan
  • Mashuga nuts
  • Nangai nuts
  • Natural nut extract (for example, almond extract)
  • Nougat
  • Nu-Nuts®
  • Nut butters (e.g., Almond butter, Hazelnut butter, Brazil nut butter, Macadamia nut butter, Pistachio nut butter, Shea nut butter, Karike butter, as well as other nut butters)
  • Nut meal
  • Nutella ®
  • Nutmeat
  • Nut oil (e.g., Walnut oil as well as other nut oils), nut paste, nut pieces
  • Pecan
  • Pigñolia
  • Pili nut
  • Pine nut
  • Pine nut (Indian, piñon, pinyon, pigndi, pigñolia, pignon nuts)
  • Pinon nut
  • Piñon or Piñon nut
  • Pinus spp. (Pineaceae) [botanical name, Pine nut/piñon nut]
  • Pistachio
  • Pistacia vera L. (Anacardiaceae) [botanical name, Pistachio]
  • Pralines
  • Prunus dulcis (Rosaceae) [bontanical name, almond]
  • Shea nut
  • Sheanut
  • Vitellaria paradoxa C.F. Gaertn. (Sapotaceae) [botanical name, Shea nut]
  • Walnut (English, Persian, Black, Japanese, California)

Other Hidden Places for Tree Nut Allergies

Tree Nuts are often found in the following items

  • Artificial flavoring
  • Baked goods (especially almond extract!)
  • Body Care Items (especially skin care products like washes, exfoliators, moisturizers, lotions, creams, etc)
  • Candy (chocolate candy especially)
  • Cereals
  • Chili
  • Energy Balls / Energy Bars
  • Grain breads
  • Granola
  • Make Up
  • Mortadella
  • Natural flavoring
  • Nougat
  • Pesto
  • Salads and Salad Dressings
  • Veggie Burgers

What You Can eat with a Tree Nut Allergy

After developing or discovering your tree nut allergy, how you eat and how you live is very likely going to change. Cooking for home is one of the safest options for you and your family as you can ensure non allergens come into contact with your food, and thus, not cross contamination. Make sure your diet is filled with simple whole foods, such as meats, grains, vegetables, fruits, beans, and lentils.  

Living with allergies has gotten so much better in the past few years thanks to the requirements of labeling all food in grocery stores, as well as the sheer quantity of allergy free alternatives available in most stores.

For a list of my favorite tree nut alternatives, and when each will work best in what recipes, make sure you grab a download of my free Food Swap Guide! It’s filled with over 45 swaps and substitutions so you can keep making your favorite recipes with your allergies.

tree nut free recipes

Check out some of my most popular tree nut free recipes on the site!

Eating Out with Tree Nut Allergies

While not the biggest change to your life with a tree nut allergy, there are some new considerations to make from the options available to you when dining out. No longer can you just go grab a quick bite to eat, nor will you be able to freely eat at a friend’s house.

The best way to avoid (or at least try to avoid) getting sick at restaurants is to research ahead of time. Most restaurants post their menus online, which gives me a chance to figure out if this restaurant would be a safe option. Even if the menu says “allergy friendly” you still should research, because it is really difficult to ensure that a chef or kitchen will wipe off any surfaces, open new bags of ingredients, or even use a different set of gloves when preparing food.

For tree nut allergies in general, you want to be wary of Vegan and Asian inspired cuisine as they both rely heavily on coconut to flavor things. Bakeries and baked goods are recommended to be avoided as the risk of almond extract or cross contamination is high.

When dining at a friend’s house, I will always ask if I can bring an option that is tree nut allergy safe.

That said, the list of the following fast food restaurants are generally considered safer to eat at when having a tree nut allergy. As always, double check before eating anything.

  • In-N-Out
  • Chipotle
  • Qdoba
  • Chick-fil-A
  • Burger King
  • Wendy’s
  • McDonald’s
  • Subway
  • Taco Bell
  • Arby’s
  • Most BBQ places
a half circle filled with mixed nuts is shown next to a list of eating seeds with a tree nut allergy

hidden sources of tree nuts

Beyond food, there are places where tree nuts can hide, making you sick even though you don’t eat nuts anymore! While you won’t be eating these things, you should be aware that a reaction can occur from touching or smelling tree nuts. These hidden tree nut places include:

  • Medications (make sure you talk to your doctor before stopping medications and ask about switching to a different medication!)
  • Toothpaste (especially organic and natural toothpastes)
  • Lotions and bath products (almond oil is in a lot of things!)
  • Make-up
  • Skin care products
  • Pet food

Make sure you check these places and use the list above to make sure that you and your family are safe from these hidden tree nut sources!

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I love when you share my recipes!

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