When Your Child Has a Food Allergy: Tree Nuts

Tree nuts are considered major food allergens under the Food Allergen Labeling and Consumer Protection Act of 2006. All food products that contain a tree nut as an ingredient must list the name of the specific nut (almonds, pecans, walnuts) on the product label. For more information about food labeling laws, go to www.foodallergy.org.

If you are unsure about any product, confirm ingredients with the manufacturer or discuss with your allergist before using.

Patient instructions: Avoid foods with these ingredients

• Almonds

• Artificial nuts

• Beech nut

• Brazil nuts

• Cashews

• Chestnuts

• Filbert/hazelnuts

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

• Hickory nuts

• Macadamia nuts

• Marzipan/almond paste

• Natural nut extract (almond, walnut)

• Nougat

• Nu-Nuts artificial nuts

• Nut butters (i.e. cashew butter)

• Nut meal/nut flour

• Nut oils

• Nut paste (i.e. almond paste)

• Nutella

• Pecans (Mashuga nuts)

• Pesto

• Pine nuts (pinyon nuts/pignoli)

• Pistachios

• Walnuts

Important information:

• Peanuts are not tree nuts. Ask your allergist if it is safe to eat peanuts.

• Many peanut and tree nut products have a high likelihood of cross-contact with other tree nuts during the manufacturing process. Read labels carefully.

• Artificial nuts can be peanuts that have been de-flavored and re-flavored with a nut, like pecan or walnut.

• Avoid natural extracts (pure almond extract). Use imitation artificial flavored extracts.

• Tree nuts have been used in many foods including barbecue sauce, cereals, crackers, and ice cream.

• Coconut is not restricted in the diets of people with tree nut allergies. Although the FDA identifies coconut as a tree nut, it is a fruit.

• Nutmeg, butternut squash, and water chestnut are safe for tree-nut allergic individuals.

• Some tree nuts cross-react with other nuts (walnut and pecan, cashew and pistachio, almond and hazelnut). Speak with your allergy team about which nuts need to be avoided and which can be safely ingested.

If your child has any of the symptoms listed below, act quickly!

If an epinephrine auto-injector has been prescribed, use it right away. Then call 911.

• Trouble breathing or a cough that won’t stop

• Swelling of the mouth or face

• Dizziness or fainting

• Vomiting or severe diarrhea

Reviewed May 2024 by Megan Lewis, MSN, CRNP and Jonathan Spergel, MD, PhD