Understanding Tree Nut Allergies: Symptoms, Treatment, and More

What Is a Tree Nut Allergy?

A tree nut allergy is one of the most common food allergies for both adults and children. Allergic reactions to tree nuts can range from mild (minor itching, watery eyes, and a scratchy throat) to life-threatening. You may be allergic to just one type of tree nut, or you could be allergic to several. Being allergic to one type actually increases your risk for being allergic to others.

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Until your allergies are thoroughly tested by your allergist-immunologist (a doctor who specializes in treating allergies and the immune system), you may be asked to avoid all tree nuts. Cross-contact between multiple tree nuts is not uncommon during a manufacturer’s processing stage.



What Are the Symptoms of a Tree Nut Allergy?

If you’re allergic to tree nuts and are exposed to them, you may develop symptoms of an allergic reaction. In some cases, these symptoms will appear within minutes and be severe. In other cases, it may take 30 minutes to a few hours before the symptoms begin.

Symptoms of a tree nut allergy may include:

  • abdominal pain, including cramping and upset stomach
  • nausea and/or vomiting
  • diarrhea
  • itching of the mouth, throat, skin, eyes, hands, or other body regions
  • shortness of breath and difficulty breathing
  • wheezing
  • nasal congestion or runny nose
  • anaphylaxis

Anaphylaxis is rare, but it’s the most severe form of allergic response. In the case of anaphylaxis, a person with an allergy will begin experiencing symptoms within five to 30 minutes of exposure to the tree nut. Symptoms of anaphylaxis include:

  • swollen throat
  • wheezing
  • passing out
  • trouble swallowing
  • vomiting
  • a red rash with hives or welts

Timeline of an anaphylactic reaction

Peanut and tree nut allergies are among the most common causes of anaphylaxis. People with a severe tree nut allergy should be prepared to respond to an allergic reaction at all times. In that case, you should keep an epinephrine auto-injector with you at all times. Common brands of auto-injectors include EpiPen, Adrenaclick, and Auvi-Q.

Risk Factors

What Are Risk Factors for Tree Nut Allergies?

It’s important to know the risk factors associated with tree nut allergies. Here are some common risk factors.

Peanut Allergy

Peanuts are not tree nuts, they are legumes, but being allergic to peanuts increases your risk for a tree nut allergy. In fact, 25 to 40 percent of people who are allergic to peanuts are also allergic to tree nuts, according to the American College of Allergy, Asthma & Immunology.

Other Tree Nut Allergies

If you are allergic to one type of tree nut, you may be allergic to others as well. To know your exact allergies, your immunologist may choose to conduct a complete allergy screening test.

Family History

If an older sibling has a tree nut allergy, younger siblings are at an increased risk. A doctor can provide guidance on testing for allergies in younger siblings.



How Are Tree Nut Allergies Diagnosed?

Tree nut allergies can be life-threatening. That’s why it’s so important to have a definitive diagnosis from an allergist. To diagnose your allergies, your allergist will conduct a skin prick test. During this test, your skin will be exposed to a wide variety of allergens. If you’re allergic to one of the allergens, your skin will react and swell or turn red.

If the results of this test are inconclusive, your doctor may request a food challenge. For this test, you will be exposed to the allergen (a specific food item) in increasing doses over the period of several hours. Due to the possibility of an allergic reaction, emergency medication should be immediately at hand during the test.


What Foods Should I Avoid if I Have a Tree Nut Allergy?

The best way to avoid or prevent a tree nut allergy reaction is to avoid tree nuts entirely. Strict avoidance of nuts and products that might contain nuts should protect you against an allergic reaction. Many doctors will recommend that patients, especially children, with a diagnosed allergy to one tree nut avoid the entire gamut of tree nuts because of the potential for an allergy to those as well.

The most widely consumed tree nuts include:

  • almonds
  • Brazil nuts
  • cashews
  • hazelnuts/filberts
  • macadamia nuts
  • pecans
  • pine nuts
  • pistachios
  • walnuts

Nut butters, nut oils, and natural nut extracts are also off limits for folks with tree nut allergies.

In the United States, food manufacturers are required to list if their foods may contain allergens, including tree nuts. You should also read the list of ingredients to be sure the food is allergen free. From time to time, some foods may come into contact with tree nuts during the manufacturing process. Food packaging often lists that potential hazard as well.

Don’t assume that a safe food will always be safe. Food manufacturers change their formulas regularly, and they may begin adding tree nuts without notice. That’s why it’s smart to read labels each and every time you pick up a food. You can never be too careful, especially if you have a severe allergy to tree nuts.

Hidden Sources of Tree Nuts

Despite the labeling guidelines in place from the Food and Drug Administration, allergens can hide in unsuspecting places. Tree nut proteins may be found in:

  • dry goods: cookies, cereals, crackers, protein or energy bars, and breakfast bars
  • desserts: candy, chocolates, ice creams, and frozen yogurts
  • beverages: flavored coffees, alcoholic beverages, and liqueurs
  • perishable goods: cold cuts, cheeses, marinades, and condiments
  • personal hygiene products: lotions, shampoos, perfumes, and soaps

Some restaurants may also use tree nuts for their recipes without clearly labeling the food in the dish’s description. That’s why open communication with your server is imperative when you’re dining in a restaurant.



How Are Tree Nut Allergies Treated?

Currently, tree nut allergies cannot be cured. The best way to treat them is to avoid exposing yourself to the allergen.



What Is Life Like with Tree Nut Allergies?

The outlook for a tree nut allergy depends on two things: your age and your allergy severity. Adults who are diagnosed with a tree nut allergy rarely outgrow it. That means once you’ve been diagnosed, you will almost certainly be allergic to tree nuts for the remainder of your life.

For children, the outlook is a bit different. Some children will outgrow their food allergies, including an allergy to tree nuts. Unfortunately, compared to other allergies such as egg or milk, the number of children who will outgrow their tree nut allergy is quite low, around 10 percent, according to one study. Children who are only mildly allergic to tree nuts (they don’t experience anaphylaxis when exposed to the allergen, for example) have a better chance of outgrowing the allergy than children who have a very severe allergic reaction to tree nuts.

Thanks to increased societal awareness about food allergies and tree nut allergies specifically, it’s much easier for people with the allergy to find safe foods and openly communicate with others about their allergies. Having an allergy doesn’t mean isolation from friends, loved ones, and others who can enjoy tree nuts freely. It just means you have to be more aware and help those around you become more aware about tree nut allergies.

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