Tree Nut Allergy Diet

General guidelines for tree nut allergy

When your child has a food allergy, they must follow an allergy-free diet. This means your child can't have the food they are allergic to, or any products containing that food. The items that your child is allergic to are called allergens.

A tree nut allergy is the immune system's abnormal response to the proteins found in tree nuts. Tree nuts include almonds, pecans, walnuts, cashews, and others. It's important to read food labels to be able to stay away from foods that contain tree nuts.

The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires U.S. packaged food items to state clearly on the label if they contain tree nuts. FALCPA requires that the specific nut be identified on the label, such as almonds. Some people with a tree nut allergy need to stay away from all tree nuts (listed below). Other people may be able to eat some tree nuts, but not others. Talk with your child's healthcare provider about the right decision for your child.

Some food makers voluntarily include precautionary labels that state, "may contain tree nuts" or "may be made in a facility where tree nuts are processed." These labels can be confusing and are not regulated by the FDA. Check with your child's healthcare provider to see if your child should stay away from foods with these labels.

The lists below may not contain all products with tree nuts. But they can help guide your decisions. It's important to always read all food labels.

How to read a label for a tree nut-free diet

Stay away from foods that have any of these ingredients:

• Almonds

• Artificial nuts

• Beechnut

• Brazil nuts

• Butternut (white walnut)

• Cashews

• Chestnuts

• Chinquapin nut

• Coconut

• Filberts

• Gianduja (a creamy mix of chocolate and chopped toasted nuts found in premium or imported chocolate)

• Ginkgo nut

• Hazelnut spread

• Hazelnuts

• Hickory nuts

• Litchi, lichee, or lychee nut

• Macadamia nuts

• Mandelonas (peanuts soaked in almond oil)

• Marzipan or almond paste

• Nangai nut

• Natural nut extract

• Nougat

• Nut butters (for example, cashew butter or almond butter)

• Nut milks, such as almond milk or cashew milk ice cream

• Nut oil, nut pieces, or nut meal

• Nut paste, such as almond paste

• Pecans

• Pesto

• Pili nut

• Pine nuts (pignolia)

• Pistachios

• Praline

• Shea nut

• Walnuts

Not all children with an allergy to tree nuts are allergic to peanuts. Talk with your child's healthcare provider about the need for your child to stay away from peanuts.

Other information about tree nuts

• Artificial nuts are peanuts that have been deflavored. They are then reflavored with a nut, such as pecan or walnut.

• Filberts is another name for hazelnuts. A child who is allergic to filberts or hazelnuts should not eat foods with these in them.

• Some natural extracts can contain tree nuts. These include pure almond extract and natural wintergreen extract. 

• Imitation or artificially flavored extracts are safe to use.

• Ethnic foods, commercially prepared baked goods, and candy can be cross contaminated with nuts. This is because nuts are often used in these types of foods.

• Tree nuts are being added to a growing variety of foods. These include barbecue sauces, cereals, crackers, and ice creams. Read all labels carefully to stay away from tree nuts.

Important points

Foods that don't contain tree nuts could be contaminated during manufacturing. Unfortunately, advisory labels such as "processed in a facility that also processed tree nuts" or "made on shared equipment" are not regulated by the FDA. They are voluntary. Companies are not required to include them. Discuss with your child's healthcare provider if your child may eat products with these labels or if they should stay away from them.

There are some foods and products that are not covered by the FALCPA law. These include:

• Foods that are not regulated by the FDA

• Cosmetics and personal care items

• Prescription and over-the-counter medicines and supplements

• Toys, crafts, pet foods

When you are not at home

For your child's general safety:

• Always carry 2 doses of epinephrine, such as epinephrine autoinjectors or nasal spray. Make sure you and those close to you and your child know how to use them.

• If your child doesn't have epinephrine, talk with their healthcare provider to see if you should carry it.

• Have your child wear a medical alert bracelet or necklace with their allergy information.

• Alert your child's teacher and school nurse about the allergy. If your child's allergy is severe enough that epinephrine is advised, make certain there are 2 epinephrine doses in an emergency kit that is always accessible during school, including at recess and on field trips.

When you are eating out:

• In a restaurant, food may be cross contaminated with tree nuts or recipes may change. Always ask about ingredients at restaurants. Do this even if these are foods that your child has eaten in the past.

• Stay away from buffets with tree nuts to prevent cross contamination of foods with shared utensils.

Online Medical Reviewers:

• Deborah Pedersen MD
• Jessica Gotwals RN BSN MPH
• Raymond Turley Jr PA-C