General Information
- Reactions to food are common and can be divided into two categories, those caused by food allergy and all other reactions
- Food allergies develop when the body’s immune system has an abnormal reaction to one or more proteins in a food that can lead to serious allergic reactions
- Other food reactions are not caused by the immune system but can cause unpleasant symptoms (examples include lactose intolerance, heartburn, food poisoning, and sensitivities)
- Tree nut allergy is one of the most common food allergies
- People with an allergy to one tree nut have a greater chance of being allergic to other types of tree nuts
- Coconut, water chestnuts and nutmeg are NOT tree nuts
- Tree nuts grow on tress and are different from peanuts (peanuts are in the legume family) - Around 30% of people with a tree nut allergy are also peanut allergic
Tree Nut Avoidance
- Tell anyone with regular contact with you or your child about the allergy and avoidance of tree nuts
- Read labels every time you buy something. Manufacturers can change products at any time - Be aware of cross contamination (transfer of tree nuts to a food that does not normally have tree nuts as an ingredient)
- Common tree nuts include:
- Almond
- Chinquapin nut
- Nangai nut
- Pine nut
- Beechnut
- Hazelnut / filbert
- Macadamia nut
- Pistachio
- Brazil nut
- Hickory nut
- Pecan
- Shea nut
- Cashew
- Ginkgo nut
- Pili nut
- Walnut
- Chestnut
- Some foods that contain or may contain tree nut protein
- Artificial nuts
- Flavored coffee
- Nut substitutes
- Araretto (almond)
- Flavored liqueurs
- Natural flavors and extracts
- Baked goods (cake, cookies)
- Gianduja / giandula
- Pastries / pies
- Barbecue sauce
- Glazes
- Pesto
- Candy
- Granola bars
- Pralines
- Calisson (almond)
- Hazelnut paste
- Salads
- Cereals / muesli
- Ice cream / frozen yogurt
- Salad dressing
- Chocolate / Candy bars
- Icing
- Satay
- Chilli
- Marzipan (almond)
- Sundae toppings
- Crackers
- Nougat
- Smoke flavor (BBQ sauce)
- Energy bars
- Nut butters (almond, cashew)
- Trail mix
- Frangelico (hazelnut)
- Nutella
- Tree nut oil
Allergic Reactions
- Symptoms often occur within minutes up to 2 hours of exposure to tree nuts:
- Outside Symptoms
- Face: Redness, itchy eyes / nose, swelling
- Skin: Itching, redness, hives, swelling
- Inside Symptoms
- Face: Swelling lips and tongue, itchy mouth
- Throat: Itching, tightness, hoarse voice, cough
- Lungs: Trouble breathing, shortness of breath
- Stomach: Vomiting, nausea, stomach pain, diarrhea
- General: Dizzy, unsteady, drowsy, fainting
- Not every reaction will look the same, a person can have different symptoms each time
- Symptoms range from mild to life threatening, there is no way to predict if the reaction will be mild or severe
- Anaphylaxis is a severe life threatening reaction with more than one body system affected (skin, breathing, stomach, general) and can occur WITHOUT skin symptoms such as hives
Treatment of Reactions
- Antihistamines such as Benadryl will NOT stop severe reactions
- An epinephrine auto injector such as Allerject or EpiPen MUST be available at all times
- If you are visiting an area without access to a hospital you should have 2 auto injectors available
- A medical identification device such a Medical Alert bracelet should be worn to outline the food allergy and that an epinephrine auto injector is carried
- Give epinephrine in the outer thigh if there are any of the following symptoms (listed in the table on the previous page)
- General symptoms
- Severe outside symptoms
- Any inside symptoms
- If you are in doubt, give the epinephrine
- After epinephrine is given
- Lie down / lie your child down
- Call local emergency service and tell them someone is having an allergic reaction
- If the reaction continues or worsens, give a second dose of epinephrine in 5 - 15 minutes (there is only 1 dose of epinephrine in each auto injector, a second dose requires a new auto-injector)
- Go to the nearest emergency room even if the symptoms are gone because the reaction can worsen or come back
- Stay in the hospital for at least 4 - 6 hours of observation
Outcomes for Tree Nut Allergic Patients
- Around 10% of people will outgrow the tree nut allergy
- Repeat skin testing and blood work every 1 - 2 years will help determine if the allergy is outgrown
- An oral food challenge (eating tree nut products in small steps ONLY in the doctors office) will be offered if your doctor feels it is safe
- Tree nut products should NEVER be tried outside of a doctors office to see if the allergy is outgrown
Additional information: www.anaphylaxis.ca or www.foodallergy.org