When a child has a tree nut allergy, exposure to even small amounts of tree nuts can cause a life-threatening reaction. For that reason, your child must avoid tree nuts and any foods that contain them. This sheet tells you more about your child’s tree nut allergy. You’ll learn what foods to avoid, what to look for on food labels, and how to prevent cross contact (when tree nuts accidentally come in contact with foods your child can safely eat).
All true nuts such as almonds and walnuts grow on trees. Peanuts are a legume and grow underground. Yet many children who are allergic to tree nuts are also allergic to peanuts. Ask your child’s health care provider whether peanuts are safe for your child. Children with tree nut allergies should avoid all of the following:
Filberts (also known as hazelnuts or cob nuts)
Pine nuts (also called piñon nuts, pignolias, pignon nuts, pignolia nuts, Indian nuts)
Any desserts that contain nuts, including cakes, candy, cookies, and pies
Artificial nuts that contain nut flavoring
Some barbecue sauces
Some chocolate candies (may have had contact with nuts)
Cold-pressed, expeller-pressed, or virgin nut oils (ask your child’s doctor if refined nut oils are safe)
Energy, health, and breakfast bars that contain nuts
Fish and chicken crusted with nuts
Natural and artificial flavorings
Granolas, muesli, and other fruit-and-nut breakfast cereals
Mangos (these are related to cashews and may not be safe for your child)
Mortadella, an Italian smoked sausage often made with pistachios
Nut butters such as almond and cashew butter
Pesto, an Italian sauce that usually contains nuts
Shelled pumpkin seeds and sunflower seeds (may be processed on the same equipment as nuts)
Specialty cheese spreads
Sweets such as almond paste, marzipan, nougat, and gianduja
Note: Talk with your child's healthcare provider about the need to avoid peanuts.
Foods your child can safely eat may come in contact with nuts during processing. This occurs most often with cookies, candy, ice cream, and dried soup mixes. Some children are more sensitive to tree nuts than others. Ask your child's health care provider about foods that carry these warnings:
May contain traces of nuts.
Made in a factory that processes peanuts and tree nuts.
Produced on equipment shared with tree nuts.
Always use caution with imported foods, especially chocolates. They may contain allergens not listed on the label.
Many nonfood products contain tree nuts or tree nut oils, including:
Hacky Sacks and beanbags
Hamster, gerbil, and bird food
Suntan lotions, shampoos, soaps, bath oils, body oils, and skin creams (if you’re not sure about a product, visit the manufacturer’s website or call the toll-free number on the package)
Foods your child can safely eat may come in contact with tree nuts at home, at school, and in restaurants. To help prevent accidental exposure:
Teach your child not to eat snacks that are given outside the home. Your child should also not sample free cookies and other snacks in stores or buy candy from vending machines.
Don’t grind nuts in a grinder you use for other foods. If you chop nuts, thoroughly wash cutting boards and knives before using them again.
Avoid using the same scoop for different ice creams.
Explain your child’s allergy to your child’s teacher and other parents.
Talk to your child’s school about having a nut-free table in the cafeteria.
Send nut-free treats to school and to parties and outings.
Be careful around salad bars and buffets, especially in Asian restaurants.
Carry a “chef card” that explains your child’s allergy to restaurant workers. You can make your own card or print one from a website on the Internet.
If one has been prescribed, use an injectable epinephrine (such as EpiPen or Adrenaclick). Then call 911 or emergency services.
Trouble breathing or cough that won’t stop
Swelling of the face and mouth
Vomiting or severe diarrhea
Dizziness or fainting
There are many areas of ongoing research that focus on understanding allergies and allergic reaction. Please check with your child's healthcare provider about new research findings that may help your child.