As with most food allergies, the best way to avoid triggering an allergic reaction is to avoid eating the offending item.
People who are diagnosed with an allergy to a specific tree nut may be able to tolerate other tree nuts, but allergists usually advise these patients to avoid all nuts. Tree nuts are often used as garnishes in salads, as an ingredient in Asian dishes, and as an ice cream topping. They may also be found in baking mixes, breading, sauces, desserts and baked goods.
Tree nuts are among the eight most common food allergens affecting adults and children, and are specifically mentioned in the Food Allergen Labeling and Consumer Protection Act (FALCPA) of 2004. This means that the presence of these items must be highlighted, in clear language, on ingredient lists. Some companies may voluntarily include information that their food products that don’t contain nuts were manufactured in a facility that also processes nuts, though such a statement is not required by law. It is important for people with tree nut allergies to read labels carefully.
Some alcoholic beverages may contain nuts or nut flavoring added in the distillation process. Most alcoholic beverages aren’t covered by the FALCPA requirements; if “natural flavors” or “botanicals” are cited as an ingredient, you may need to call the manufacturer to determine whether that indicates the presence of nuts or nut flavoring.
Tree nut oils, which may contain nut protein, can be found in lotions, hair care products and soaps; those allergic to tree nuts should avoid using these products. Fortunately, allergists are specially trained to help identify these hidden sources of tree nut allergens.
Tree nuts and peanuts
There’s often confusion between peanuts and tree nuts. Peanuts are legumes, not nuts; still, between 25 and 40 percent of individuals who are allergic to peanuts also react to at least one tree nut, according to studies.
Allergists generally advise people who are allergic to tree nuts also to avoid peanuts because of the risk of cross-contact and cross-contamination between tree nuts and peanuts in food processing facilities. If you or your child is allergic to either peanuts or tree nuts, ask your allergist whether you should avoid both products.
The prevalence of these allergies in children appears to be growing, according to a 2010 study that compared data from telephone surveys of 5,300 U.S. households in 1997, 2002 and 2008. In the 2008 survey, 2.1 percent of respondents reported having a child with an allergy to peanuts, tree nuts or both. In the 2002 survey, 1.2 percent of subjects said they had a child with one or both of these allergies; five years earlier, in 1997, only 0.6 percent of respondents reported having a child with one or both of these allergies.
Allergies to tree nuts and peanuts are among the most common causes of anaphylaxis in the United States. An allergist will advise patients with these allergies to carry an auto-injector containing epinephrine (adrenaline), which is the only treatment for anaphylactic shock, and will teach the patient how to use it. If a child has the allergy, teachers and caregivers should be made aware of his or her condition as well.
People with tree nut allergies often wonder if they must also avoid coconut and nutmeg.
Coconut is not a botanical nut; it is classified as a fruit, even though the Food and Drug Administration recognizes coconut as a tree nut. While allergic reactions to coconut have been documented, most people who are allergic to tree nuts can safely eat coconut. If you are allergic to tree nuts, talk to your allergist before adding coconut to your diet.
Nutmeg is a spice that is derived from seeds, not nuts. It may be safely consumed by people with a tree nut allergy.
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