Tree Nut Allergies

Tree nut allergies are one of the nine most common food allergies in children and adults. Tree nuts can cause a severe, potentially fatal, allergic reaction (anaphylaxis). Medical experts and allergists advise that to prevent a reaction, strict avoidance of tree nuts and tree nut products is essential. Always read ingredient labels and ask restaurant employees to identify tree nut ingredients. Communication is the key for ensuring a safe, enjoyable allergen free meal. Use or “Food Allergy Translate App” or your “Personal Food Allergy Translate Cards” to gain better understanding!


An allergy to tree nuts tends to be lifelong. Recent studies have shown that approximately 8-10 percent of children with a tree nut allergies eventually outgrow their allergy. However, around 20% of cases can become worse with time. Tree nuts include, but are not limited to: walnut, almond, hazelnut, cashew, pistachio and brazil nuts (see list below). These nuts are not to be confused or grouped together with peanut, which is a legume, or with seeds, such as sesame, which belongs also to the nine most common food allergens.

Somebody with an allergy to one type of tree nut has a significant higher chance of being allergic to other types (that is the main reason behind grouping tree nuts together). Therefore, many experts advise patients with allergy to tree nuts to avoid all nuts or at least test sensitivity. The likelihood of cross-contact with tree nuts during manufacturing and processing is one of the highest among food allergens. Patients may also be advised to be careful with peanut products even without having peanut allergy because of greater risk of tree nuts contamination due to industrial mass processing.

Avoiding tree nuts might be extremely difficult. Always read all product labels carefully and ask questions, be prepared before purchasing and consuming any item. Ingredients in packaged food products may have unexpected sources of tree nuts, so check ingredient statements and allergen-labelings. Tree nuts are basic ingredients in many restaurant meals (esp. salads, vegetarian dishes, desserts). Always ask questions about ingredients before eating a food that you have not prepared by yourself.

Allergic reactions

Signs and symptoms of a reaction develop quickly and can rapidly progress from mild to severe. Symptoms can vary from breathing difficulties, drop of blood pressure to hives or red and itchy skin, anxiety, distress, weakness, diarrhea, vomiting, etc. Solutions involve an exclusion diet and complete avoidance of foods that may be contaminated with tree nuts or derivatives of tree nuts. The most severe nut allergy reaction is anaphylaxis, an emergency situation requiring immediate attention and immediate medical treatment.

Avoid foods

Avoid foods that contain tree nuts or any of these ingredients:

  • Almond
  • Artificial nuts
  • Brazil nut
  • Beechnut
  • Butternut
  • Cashew
  • Chestnut
  • Chinquapin nut
  • Coconut
  • Filbert/hazelnut
  • Gianduja (a chocolate-nut mixture)
  • Ginkgo nut
  • Hickory nut
  • Litchi/lichee/lychee nut
  • Macadamia nut
  • Marzipan/almond paste
  • Nangai nut
  • Natural nut extract
    (e.g., almond, walnut)
  • Nut butters (e.g., cashew butter)
  • Nut meal
  • Nut paste (e.g., almond paste)
  • Nut pieces
  • Pecan
  • Pesto
  • Pili nut
  • Pine nut
    (also referred to as
    Indian, pignoli, pignolia,
    pignon, pinon, and pinyon nut)
  • Pistachio
  • Praline
  • Shea nut
  • Walnut


Tree nut is found

Interesting: Coconut is a seed of a tropical fruit. Therefore coconut is not always considered as a tree nut for the purposed of food allergen labeling in most countries and are not usually restricted from the diet of someone allergic to tree nuts. Most people who are allergic to tree nuts can safely eat coconut products, especially coconut oil. If you are allergic to tree nuts, test your sensitivity to coconut.

If you do not recognize an ingredient or there is no ingredient list available, simply avoid the product. Many countries require that all packaged food products that contain tree nuts or peanut as an ingredient must list at least the word “Nuts” on the label. However this is not the case in all countries, especially in Asia and Africa. Many restaurants are especially not following such guidelines and no long-term solutions exist for informing guests with food allergies about the potential presence of the 9 major allergens. Do not let that eating out becomes one of your top concerns.

Some unexpected sources of tree nuts may be found in cereals, crackers, cookies, candy bars, chocolates, energy bars, flavored coffee, frozen desserts, marinades, barbeque sauces and some cold cuts, such as mortadella. Asian, African and vegetarian restaurants, ice cream parlors, bakeries and chocolate shops are considered high-risk places for people with tree nut allergy due to the common use of different kind of nuts and the possibility of cross contamination may be significant, even if you order a tree-nut-free item. Tree nut oils may still contain nut protein and should be avoided. Tree nut oils are often used in cosmetics such as lotions, hair care products and soaps as well.

High risk countries

High risk countries to travel with tree nut allergies:

  • All over the world we are exposed to the risk of allergic reactions, what we're trying to reduce with our application in 33 languages.

With clear communication food allergies can be effectively managed!
According to experts and allergist the most effective and therefore best way to manage a food allergy is total avoidance. Novel solutions of communication seem to be a proven treatment for food allergies. Our Food Allergy Translate tools are contribution strategies to minimize your risk of accidents.

Eating out with food allergy?!

Reduce your risk dramatically by using our Food Allergy Translate App or Personal Food Allergy Translate Cards to communicate your allergy alert in a foreign language.
Let the food service personnel know of your food allergy in advance. At least they should take extra care in preparing your meal!

Be prepared to communicate your needs in any restaurants. Let the restaurant/catering staff informed for avoiding the potential presence of the nine major allergens.

National Institutes of Health, NIAID Allergy Statistics;
National Report of the Expert Panel on Food Allergy Research, NIH-NIAID 2003;
American Academy of Allergy, Asthma and Immunology (ACAAI), Tree Nut Allergy;
Food Allergen Labeling and Consumer Protection Act of 2004;
Stanford Alliance for Food Allergy Research (SAFAR). California 2013)