What is a tree nut allergy?
A tree nut allergy occurs when the body reacts to the proteins in one or more tree nuts.
The tree nuts considered as allergens are almonds, Brazil nuts, cashews, hazelnuts (filberts), macadamia nuts, pecans, pistachios and walnuts. Peanuts are treated as a separate allergen because they are part of the legume family and grow underground.
How serious is a tree nut allergy?
Tree nut allergy reactions are different for each child, but they usually happen soon after exposure to tree nuts. A tree nut allergy carries the risk of anaphylaxis, a severe and life-threatening allergic reaction. Some children are so sensitive to tree nuts that inhaling a small amount of nut protein can trigger a reaction.
Tree nut and peanut allergies
Some children who have tree nut allergies also have peanut allergies. Peanuts are not tree nuts; they are actually legumes (like peas and lentils), but the proteins in peanuts are similar to the ones in tree nuts. This is why some children are allergic to both.
Other names for tree nuts
Tree nuts can have other names in ingredient lists. Learning these names can help you catch any hidden sources of tree nuts in food.
When buying packaged foods, always check the list of ingredients in the store and again when you bring the product home. It is also a good idea to check the ingredients every time you buy the food in case the recipe has changed. You can also call the manufacturer to ask about any recipe changes.
The following table lists the range of names for tree nuts. Use it when you are grocery shopping or calling food manufacturers.
| Almonds | Anacardium nuts |
| Brazil nuts | Cashews |
| Hazelnuts (filberts) | Macadamia nuts |
| Pecans | Pinon |
| Pistachios | Walnuts |
Possible sources of tree nuts
Tree nuts are used in a range of dishes, packaged foods and snacks. Below is a list of some of the many food products that can contain tree nuts.
| African, Chinese, Indonesian, Mexican, Thai and Vietnamese dishes, for example curries, egg rolls or satays | Artificial nuts (peanuts that have been altered to look and taste like almonds, pecans and walnuts), also known as mandelona or Nu-Nuts |
| Baked goods and mixes | Cereals and muesli |
| Chocolate | Crackers |
| Desserts (for example baklava) | Dressings, sauces, gravy |
| Marzipan (almond paste) | Natural flavourings and extracts (such as pure almond extract) |
| Nut butter, meats and pastes | Nut oil, peanut oil |
| Tempeh | Til |
| Snack foods, such as beer nuts | Spreads (for example cheese or hazelnut spreads) |
What do I do if my child has a tree nut allergy?
Your child should see an allergist (a doctor who specializes in diagnosing and treating allergies) who can discuss the tree nut allergy with you in more detail. Children who have a tree nut allergy usually should avoid all products that may contain tree nuts.
Your child’s doctor will also prescribe a medication called an epinephrine auto-injector, which can be used to treat allergic reactions, in case your child accidentally eats a food containing tree nuts.
If my child has an allergy to one type of tree nut, must they avoid all tree nuts?
If your child is allergic to one type of tree nut, their allergist may recommend that they avoid all tree nuts. In some cases, your child’s allergist may advise your child to only avoid specific tree nuts; however, you should be aware of the risk of cross-contamination (see below). Your child does not need to avoid peanuts unless your child has had an allergic reaction peanuts or they have been advised to do so by their allergist.
Can my child eat coconut and nutmeg?
Coconut is the seed of a fruit and nutmeg comes from the seeds of a tropical tree. A child who is allergic to tree nuts can usually still eat these foods.
Reducing the risk of cross-contamination
Cross-contamination occurs when one substance unintentionally comes in contact with another substance, for example a potential allergen. If the substances mix together, one substance taints the other substance, making it unsafe to eat.
Food allergens can contaminate other foods when, for example, the same containers, utensils or frying pans hold a range of foods.
Bulk food containers pose a high risk of cross-contamination because they are often used for different products.
Be sure to avoid using utensils or containers that may have come in contact with allergy-causing foods and ask about possible cross-contamination when eating out.
How can my child get the right mix of nutrients if they must avoid tree nuts?
The main nutrients in tree nuts include protein, omega-3 fats, dietary fibre, magnesium, phosphorus, potassium, folate and vitamin E. Your child can still get these nutrients even if they must avoid tree nuts.
Nutrients in tree nuts that are also in other foods
| Nutrient | Where to find it |
|---|---|
| Protein | Meat, fish, poultry, eggs, cheese, milk, beans, soy |
| Omega-3 | Flaxseed oil, edamame (soybeans), radish seeds, omega-3 eggs fortified with DHA |
| Fibre | Vegetables, fruit, whole grains |
| Magnesium | Wheat germ, peas, pumpkin, squash or sesame seeds |
| Phosphorus | Wheat germ, rice bran, wheat bran, cheese, beans, sardines, tempeh |
| Potassium | Bananas, papaya, sweet potato, leafy green vegetables, milk, yogurt, beans (navy, pinto, black beans), lentils, chickpeas, beef, pork, fish |
| Folate | Leafy green vegetables, beans (navy, pinto, kidney, garbanzo), lentils |
| Vitamin E | Spinach, red pepper, Swiss chard, wheat germ cereal, egg, almonds, sunflower seeds |
When to see a dietitian for a tree nut allergy
If you have removed many foods from your child's diet because of a tree nut allergy, it may be a good idea to speak to a registered dietitian. The dietitian can review the foods your child still eats to decide if they are getting enough nutrients. If necessary, they can also recommend alternative foods that your child can eat safely.
Will my child always have a tree nut allergy?
Yes, like a peanut allergy, tree nut allergies are likely to be life-long.
When to go to the emergency room
If your child is having a severe allergic reaction to tree nuts, call 911 or go to your nearest emergency department immediately. If your child’s doctor prescribed them an epinephrine autoinjector, administer this medication to your child right away. See Anaphylaxis: How to recognize and respond to a severe allergic reaction for more information.
Further information
Health Canada. Tree nuts – One of the ten priority food allergens