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Peanut and Tree nut Allergies

It’s estimated that more than 7 million children suffer from a nut allergy, making nut allergies one of the most common (and potentially dangerous) food allergies. Most of these allergies are mild, but some nut allergies can be very severe and result in anaphylaxis, which is a true medical emergency.

Despite the fact that many children who have tree nut allergies are also allergic to peanuts, tree nuts and peanuts actually belong to different food groups. Peanuts are legumes, or related to beans, instead of true tree nuts. There is a 25-40% chance that a child with a peanut allergy will also develop a tree nut allergy. Of these children, about 20% will eventually outgrow their peanut allergies and about 10% will outgrow their tree nut allergies.

Depending on the severity of the allergy, your child may experience a range of symptoms, including:

  • Skin reactions, such as hives, redness, or swelling
  • Itching or tingling in or around the mouth and throat
  • Diarrhoea, stomach cramps, nausea or vomiting
  • Tightening of the throat
  • Shortness of breath or wheezing
  • Anaphylaxis

Tree nuts include:

  • Almonds
  • Brazil nuts
  • Cashews
  • Chestnuts
  • Filberts
  • Hazelnuts
  • Hickory nuts
  • Macadamia nuts
  • Pecans
  • Pine nuts
  • Pistachios
  • Walnuts

Nuts are also commonly used in processed and prepared foods. Most food manufacturers label their products if they contain allergens such as nuts, so it’s always a good idea to read the label on any food product. Common foods with nuts include:

  • Baked goods: cookies, biscuits, pastries, etc.
  • Sweets: chocolate, nougat and marzipan
  • Cereals and granola
  • Chex mix
  • Grain breads
  • International foods (nuts are common in African and Asian cooking, as well as Mexican and Mediterranean foods)
  • Meat-free burgers
  • Sauces: hot sauce, pesto, gravy, mole sauce, glazes, or marinades
  • Salads and salad dressing

Also avoid nut butters, nut pastes, nut oils, peanut flour and nut extracts

If your child has a confirmed nut or peanut allergy, the best treatment is to avoid nuts (which also means avoiding foods that have been manufactured in facilities that process nuts). Also, be aware that nuts can be found in other products, such as lotions, shampoos, and pet food.

If your child’s allergies are severe, you might be advised to carry an Auvi-Q or Epi-Pen (epinephrine shot) at all times, as well as provide one to all caregivers in case your child accidentally consumes something with nuts. You will be instructed on how to use the Epi-Pen in the event of an emergency, and you should also teach your child how to use it as soon as they are old enough to understand the instructions.

There is also some evidence that desensitization—giving children with peanut allergies increasing doses of peanut flour or peanut extract over time in the controlled setting of an allergist’s office or even the intensive care unit—can help children get over their allergy (never try this at home!). More studies are needed, and your paediatrician can supply more information about how to deal with nut allergies. The Food Allergy and Anaphylaxis Network is also a great resource for parents with children who have nut allergies.


  • Fleischer, D.M, The natural history of peanut and tree nut allergy
  • (June 2007) Current Allergy and Asthma Reports 7(3):175-81.
  • Nut allergies. Pediatr Allergy Immunol, 2008 Jun;19(4):368-73.

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