Tree nuts — which include almonds, cashews, walnuts and several other nuts — are among the eight most common food allergens. An estimated 0.5 to 1 percent of the U.S. population has a nut allergy, usually which begins during childhood and lasts for a lifetime.
Here’s an alarming finding for parents: Studies show that reactions caused by unknown nut allergies spike during Halloween and Easter, holidays in which children are commonly given candies and other treats that contain ingredients they aren’t accustomed to eating. This can cause sudden food allergy symptoms, such as hives and digestive upset, or rarely more severe issues, including trouble breathing.
How can you best manage a nut allergy? Because a cure or treatment isn’t available, a strictly nut-free diet is often the only way to prevent symptoms.
Let’s take a look at which foods are most likely to trigger a reaction, as well as steps you can take in the case of an allergy emergency.
What Is a Nut Allergy?
A nut allergy is an allergic reaction to nuts. An allergic reaction happens when someone’s immune system reacts to a specific molecule in a food, causing increased production of antibodies that triggers an inflammatory reaction.
This involves the release of chemicals called histamines, which lead to allergy symptoms, including hives, swelling of the mouth and so on.
What nuts are included in nut allergies? Technically, “tree nuts” include:
Nuts are defined as hard-shelled pods that contain both the fruit and seed of the plant. “Drupes” are types of tree nuts and include peaches, mangoes, pistachios, coconuts, almonds and cashews.
Peanuts are actually legumes (edible seeds enclosed in pods) and not nuts. They are related to foods like beans, lentils, chickpeas and peas.
Even though not technically nuts, peanuts still very commonly cause allergies.
Which nuts cause most allergic reactions? In both children and adults, peanuts are one of the most common foods that cause life-threatening allergic reactions.
Along with shellfish, they are the most common food allergen and the leading cause of allergy-related death in children.
Is a peanut allergy the same as a nut allergy? Not necessarily.
Some people are allergic to peanuts but not allergic to tree nuts or seeds (such as sesame seeds, sunflower seeds, etc.). However, a relatively high percentage of those with peanut allergies also react to other tree nuts.
The American College of Allergy, Asthma & Immunology reports that up to 40 percent of people with peanut allergies are also allergic to at least one tree nut. If you have an allergy to one type of tree nut, then you have a greater chance of also being allergic to other nuts, which is why experts usually advise people with any known tree nut allergy to avoid eating all nuts.
Nut allergies differ from person to person. If you have a nut allergy, nuts and seeds that you may need to avoid include:
- Brazil nuts
- hickory nuts
- macadamia nuts
- pecan nuts
- pine nuts
- sesame seeds (the most common seed allergy)
- sunflower seeds
- poppy seeds
- coconut (rarely)
Some people need to avoid all or most types of nut trees, while others only react negatively to one or several types. This ultimately depends on the person’s unique immune system.
Nut Allergy Spike During Halloween
Experts have observed an increase in nut allergy symptoms around the time of Halloween and Easter, presumably because children (and some adults too) tend to eat candies and other treats that they normally don’t consume very often.
One study published in the Canadian Medical Association Journal found that there was an 85 percent increase in severe peanut-related allergic reactions (anaphylaxis) during Halloween, as well as a significant increase in reactions to other nuts. Similarly, Easter was another time when allergic reaction spiked.
The people who experienced these reactions were mostly children who were not aware that they were consuming nuts and didn’t know they had an allergy.
Nuts can be found in many types of chocolates, candies, desserts and packaged treats, leading to symptoms among children who have not been previously exposed.
Are nut allergies increasing? There’s reason to believe that more and more children are experiencing nut and peanut allergies compared to in past decades.
What recently caused a sudden increase in peanut allergies? The reason that nut allergy symptoms are increasing is unclear.
There are several theories as to why more people are developing food allergies, including:
- The negative effects that an unhealthy lifestyle and poor diet have on the immune system.
- The “hygiene hypothesis,” mostly which affects people living in industrialized nations. This describes how over-sanitizing people’s bodies has changed their microbiomes and left them more susceptible to allergies
- Environmental pollution
- Less exposure to microbes and potentially increased use of antibiotics
Here are some other statistics and facts about nut allergy trends:
- Food allergies in general affect about 15 million Americans. Peanut allergies are more common in children than adults. They affect an estimated 2.5% of children and 1.2% of adults living in the U.S.
- According to an article published in the AJMC journal, the prevalence of peanut allergies in the United States more than tripled between 1997 and 2008, with a recent study finding another 21% increase since 2010.
- Peanuts and tree nuts account for most fatal cases of food-related anaphylaxis in North America.
- There was a five-fold increase in peanut allergies in the U.K. between 1995 and 2016.
- Australia has the highest rate of confirmed food allergies, with an estimated 3% of the population allergic to peanuts.
- A peanut allergy is the single most common allergy in children.The prevalence of nut allergies in children also appears to be growing. One large-scale study found that in 1997, only about 0.6 percent of respondents had a child with a nut allergy — however by 2008, 2.1 percent of respondents reported having a child with an allergy to peanuts, tree nuts or both.
What happens if someone with a nut allergy eats nuts? It depends on how allergic that person is to the nut/seed that he or she is exposed to.
Some people experience mild reactions, while others have severe food allergy symptoms (known as anaphylaxis). Anaphylaxis occurs as a result of the activation of immunoglobulin E (IgE) in the body, which will cause the most severe symptoms and sometimes can be fatal.
The most common nut allergy symptoms include:
- red bumps of skin (hives) and itchy skin
- runny nose
- swelling of the lips
- tingling of the throat and mouth
- tightening of the throat
- cramps, indigestion, pains, nausea or vomiting
- difficulty talking or a hoarse voice
- wheezing or persistent cough
- persistent dizziness or collapse
- paleness and weakness
Why are people allergic to nuts? It’s not entirely known why nuts and peanuts are such common allergens, however genetics and lifestyle factors seem to play a role.
What we do know is that a nut allergy is caused by increased release of IgE, an antibody that binds to allergens and triggers the release of chemicals that causes symptoms.
Can you all of a sudden become allergic to nuts? While “adult onset food allergies” do affect some people, they are rare.
Much more often a child will develop a nut allergy. Sometimes they may outgrow it but usually do not.
It’s believed that about 9 percent of children with a tree nut allergy eventually outgrow their allergy. This means that about 90 percent of children with a nut allergy to peanuts need to be cautious even as they get older.
How to Reduce Risk
1. Speak With Your Doctor First
First and foremost, if you suspect you have a tree nut allergy, visit a clinical immunology or allergy specialist. You can ask your doctor for a referral if you’re unsure of whom to visit.
Your doctor, or an allergy specialist, may decide to help diagnose your allergy by performing a skin prick test or a blood test.
He/she might also suggest that you follow an elimination diet and avoid all nuts and products containing nuts so you can track your symptoms. Then you reintroduce nuts to your diet under medical supervision in order to determine if this triggers your symptoms.
2. Avoid All Foods Containing the Nuts You’re Allergic To
There isn’t currently a treatment for most food allergies. The only guaranteed way to control tree nut allergy symptoms is to avoid all products containing the foods that you’re allergic to.
Unfortunately, tree nut allergies tend to be lifelong conditions, which means a restrictive diet may need to be followed forever.
For people with food allergies, it’s really important to read ingredient labels carefully. In countries such as the U.S., labeling on packaged foods is required for 18 different tree nuts.
The goal is to identify any food or food product that contains the nuts/seeds you’re allergic to and then to strictly avoid having any. Depending on how severe your allergy is, you may need to eliminate food products from your diet that “may contain” or are “processed in a facility that also manufactures” potential allergens.
Foods to avoid or to only eat with caution if you have a known nut allergy include:
- Nut butters
- Trail mixes
- Granola and granola bars
- Certain peanut-flavored sauces, dressings and marinades (especially those used in Asian, African and Indian cuisines)
- Candies and chocolate (including Halloween candies, such as Snickers, Almond Joy, Mounds, many milk chocolates and brittles, and others)
- Packaged baked goods and desserts
- Prepared soups and chili
- Packaged mixes
- Some soaps, skin lotions, hair care products
- Some alcoholic drinks
If your child is given candies and treats from other people, such as during Halloween or at parties or even school/daycare, you’ll want to monitor what they’re consuming. This is especially important if they’ve ever shown signs of having a nut allergy.
Make sure to have your children wash their hands thoroughly and often if around nuts/seeds that they are allergic to, and be sure to clean surfaces with cleaning sprays or sanitizing wipes to remove residues.
Be sure to make other adults and children aware of your children’s allergy, which reduces the chance that they’ll be given a triggering food. You should also explain to your children that they’ll need to avoid homemade treats during Halloween and at school and parties because you can’t be sure which ingredients they contain.
You can try keeping food allergy alternatives on hand, such as treats made with coconut, honey and sunflower butter (assuming you know your child isn’t allergic to these foods).
3. Have an Action Plan If You Have a Reaction
If you or your child has been diagnosed with a tree nut allergy, speak to your doctor about making an action plan to help manage a potential allergic reaction.
Your doctor might choose to prescribe you an adrenaline (epinephrine) autoinjector (such as an EpiPen®), which can be used when a serious reaction occurs. Epinephrine (adrenaline) is currently the only treatment for anaphylactic shock.
Here are other ways to help manage nut allergy symptoms and reactions:
- Lay the person flat if that person is in shock, rather than having her/him to stand or walk. This is a good time to administer adrenaline with an autoinjector (such as an EpiPen®) right away.
- Dial triple zero (000) to call an ambulance in a medical emergency.
- Wear medical identification jewelry or carry a card identifying your allergy, which can hep someone give you adrenaline during an emergency.
- Talk to your doctor about avoiding medications that can increase the severity of allergic reactions, including beta blockers.
- Peanuts, tree nuts (such as almonds, cashews, pistachios, walnuts and hazelnuts) and seeds are some of the most common food triggers for life-threatening severe allergic reactions.
- Nut allergy symptoms differ from person to person but can include digestive issues, rashes, swelling of the mouth and lips, trouble breathing, changes in blood pressure, and more.
- The only way to avoid nut allergy symptoms is to avoid all food products containing the nuts/seeds that you’re allergic to. This means being very careful about consuming nut butters, trail mixes, candies, chocolate, cereals, granola, snack bars, desserts and sauces.
- Because nut allergy symptoms spike during Halloween and Easter, parents should monitor their children’s intake of treats, consider providing allergy alternatives instead and be very precautions if a child has a known nut allergy.