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Tree Nut Allergy Avoidance

The Asthma Center, Allergic Disease Associates, P.C.
Professional Arts Building
205 North Broad Street, Ste 300
Philadelphia, PA 19107


Tree nut allergies are very common and can be very severe in adult and pediatric individuals. Tree nut allergic individuals should avoid all nuts until each nut is evaluated for safety for the particular individual. As with peanuts, tree nuts are not a primary source of any one nutrient, and therefore tree nut-avoidance diets do not present any significant nutritional risk to the individual.

Ingredient Terms that Indicate the Presence of Tree Nuts
The following is a partial list of terms  commonly used on food labels to indicate the presence of tree nuts. This list should be distributed to any caregiver, relatives or food service worker who will be providing food to the tree nut allergic individual. Individuals with tree nut sensitivity should avoid all foods containing these ingredients, unless the particular nut has been evaluated as safe for the particular individual.

  • Almonds
  • Artificial Nuts
  • Brazil Nuts
  • Cashews
  • Chestnuts
  • Filbert/hazelnuts
  • Gianduju (a creamy mixture of chocolate and chopped toasted nuts found in premium or imported chocolate)
  • Hickory Nuts
  • Imitation Nuts
  • Macadamia Nuts
  • Marzipan/almond paste
  • Nougat
  • Nut Butters (Such as Cashew butter)
  • Nut Meal
  • Nut Oil
  • Nut Paste (pinon, Indian nuts, pignoli)
  • Pistachio
  • Walnuts

Hidden Sources of Tree Nuts
As with peanuts, hidden sources of tree nuts are very common. For example, pure almond extract might contain enough almond protein to elicit a reaction in certain almond allergic patients. Because many nut products are processed on the same manufacturing equipment, specific tree nut allergic individuals should consider avoiding all processed nut products.

Additionally, some soaps like Dove for sensitive skin may be formulated include almond oil.  Labels for cosmetics and bath products should be read because these products may contain food proteins.

The possibility of allergic reaction to tree nuts through kissing has been reported and is usually not thought of by people with tree nut allergies.   Teenagers and young adults may be particularly at risk during dating to this hidden contact source. Individuals of any age though, should be aware of this vulnerability. Pet food may also contain protein from tree nut. For children and adults extremely sensitive to tree nuts, even trace amounts of tree nut exposure from animal saliva may cause a reaction.

The Food Allergy and Anaphylaxis Network
A registry of patients with tree nut sensitivities is maintained through the Food Allergy and Anaphylaxis Network (FAAN) based in Fairfax, Virginia.  It may be worthwhile reporting you or your child's particular nut sensitivity to this resource for future information regarding food labels and potential sources of reaction. FAAN also publishes a number of resources for individuals with food allergies including a bi-monthly newsletter called Food Allergy News.  Cookbooks and videos are available. FAAN also provides to members a convenient, laminated wallet-sized chart that delineates how to read a food label for a tree nut-free diet.  Their phone number is 1-800-929-4040, and their website is

What Consumers Can do to Help Identify Allergens
If a consumer finds that a product causes a reaction, besides discussing it with your physician at the Asthma Center, please notify the manufacturer and notify the local FDA consumer complaint coordinator (The following provides a list of phone numbers in the US)

In addition, consumers should continue to provide input about concerns and suggestions for allergen labeling issues by emailing comments to and noting Docket OOP-1322.

Printed with permission from The Asthma Center, copyright 2008