Hidden Sources of Tree Nuts & Nut Allergy Information

Peanut and tree nut allergies are at the center of food allergies these days. They are the major allergens we read about the most, and also what many food manufactures are voluntarily labeling for. There have been a lot of awareness campaigns and allergy education about these two allergies because they have some of the most severe reactions, and have caused many deaths.

You can be allergic to one, some, or all tree nuts. No two people are the same. For some, the allergy to one tree nut causes a cross-reactive allergic reaction to other tree nuts. For others, they can eat several types of nuts just fine. Some people, based on their testing and past reactions, are advised to avoid all nuts for safety reasons.

Again, no two people are the same, and you’ll need to work with your medical team/healthcare provider to ensure you’re doing what’s best for you/your child.

Know that this article contains a wide variety of information relating to tree nuts, and the table of contents should be used liberally.

What is a Food Allergy?

A food allergy is a response by your immune system that’s triggered by a protein that your body sees as a threat. This is not the same thing as a food intolerance or an autoimmune disease. If you suspect you have a food allergy, ask your healthcare provider/main doctor to refer you to an allergist for allergy testing where a blood test and/or skin prick test can be ordered to determine if you have an allergy. Know that tests are not 100% accurate, but are still a good diagnostic tool.

A “true” food allergy is IgE mediated, and the immune system usually elicits a reaction within immediate ingestion to four hours. Outside of that window, it’s usually suspected that you have a food intolerance.

However, there are some types of allergenic diseases that are “true” food allergies and the reactions happen outside of the four hour window. Additionally, a person can have a more rare or complex case and suffer from delayed reactions (which can still be “true” food allergies).

In some patients, they have what’s called contact or airborne allergies as well. This tends to be a bit more common in those with peanut and tree nut allergies. In their case, a reaction can be triggered by touching the food or by breathing in its particles (like when cooking or baking). Food allergies can be life threatening and should always be taken seriously. Work with your allergist and healthcare providers to create an action plan that will meet your needs.

Symptoms of a Tree Nut Allergy

Food allergy reactions can vary among patients, as no two people are the same. Some allergy symptoms of a nut allergy include:

Swelling of the Lips
Swelling of the Tongue
Swelling of the Throat
Itchy Mouth and/or Throat
Shortness of Breath
Difficulty Breathing
Wheezing
Skin Rashes
Itching
Hives
Racing Heart Rate
Decreased Blood Pressure
Impending Doom/Dread
Dizziness
Fainting/Loss of Consciousness
Severe Stomach Pain
GI Distress
Nausea
Vomiting (including projectile vomiting)
Diarrhea
Blood in Stool

These symptoms are more on the severe side of the allergic reaction spectrum, and can indicate anaphylaxis. It’s critical that if you see these tree nut allergy symptoms that you seek immediate medical help. If you have a known allergy, follow your action plan.

There are hundreds of symptoms a person can experience, but it’s important to know three things about nut allergy symptoms and reactions:

Not every reaction is anaphylaxis. People can have a “non-traditional” tree nut allergy reaction to food and still be allergic to one or more nuts.
Should a person experience anaphylaxis, it’s important to seek immediate medical treatment (use your epinephrine injector if you have one). When left untreated, anaphylaxis can lead to anaphylactic shock, which can cause death.
Previous allergic reactions don’t predict future reactions (or the severity), and in some patients, continued exposure to known allergens can cause more severe reactions each time.

A child may talk about a food allergy differently than adults. Many children will say things like “my mouth is spicy” or “there’s a frog in my throat”. They’re trying to express what the reactions feel like to them with language or experiences that are familiar to them. Always take note of these types of statements from a child, as they can indicate a serious medical situation. If needed, don’t hesitate to seek medical treatment.

Determine Your Level of Sensitivity to Nuts

When you’re managing a tree nut allergy, it’s important that you understand how sensitive you are. This will help you read packages better, understand what types of questions to ask companies when you call, and so on. To understand the different levels of sensitivity, here’s how I like to look at food allergens (“it” refers to an allergen):

Is it in the main ingredients
Is it a processing aid
Is it on the equipment (shared equipment)
Is it in the facility
Is there transportation or storage exposure to the allergen

When it comes to levels of sensitivity, you’ll need to know what you can handle in terms of shared equipment and shared facilities. It really boils down to: can you handle trace amounts of the allergen? No matter where you fall on the list/bell curve, it’s always safe to call/email companies and manufacturers to find out about their processing and production of a product.

For example, I was talking with a friend who works in the chocolate space and they shared that if you’re allergic to milk, peanuts, or tree nuts, you should never purchase chocolate that’s processed on shared equipment with those allergens. The equipment can be difficult to clean from all residue, and the risk for cross-contact is high.

Some manufacturers will tell you things like this whilst others won’t. Keep this in mind as you go about buying different goods to try.

How to Read Food Labels When You Have a Nut Allergy

Nuts are considered a major allergen here in the U.S. and around the world (top 8, top 9, top 10, top 12, and top 14). Food labels should clearly indicate if tree nuts are an ingredient on the ingredient list of the package. The FDA has pretty strict guidelines on how tree nuts have to be labeled on a package.

For example, a package can’t simply say “tree nuts”. Instead, it must list the specific tree nut that’s in the ingredients. Additionally, the major allergen must be called out. You’ll sometimes see it in bold, but you’ll also see a something like “Contains: Soy, Almonds, Hazelnuts“ at the bottom of the ingredient list.

When you have a tree nut allergy, it’s important to know that not every tree nut falls under the allergen labeling law. Here in the United States, the tree nuts that are considered major allergens are:

Almond
Black Walnut
Brazil Nut
California Walnut
Cashew
Hazelnut (Filbert)
Heartnut (Japanese Walnut)
Macadamia Nuts (Bush Nut)
Pecan
Pine Nut (Pinon Nut)
Pistachio
Walnut (English Walnut, Persian Walnut)

As of January 1, 2025, coconut was removed from this list by the FDA for labeling.

There’s a Lot That’s Not on the Label

Here in the U.S. and around the world, there’s a lot of details that aren’t on food labels. That includes:

If the food was processed on shared equipment with tree nuts.
If nuts are present in the manufacturing facility.
If the raw materials came into contact with tree nuts in any way including storage.

The good news is that companies keep good records and details about major allergens. Since nuts are a major allergen here in the United States and abroad, you should be able to contact a company and get detailed answers. Manufacturer’s can also reach out to their supply chain from start to finish to make sure tree nuts aren’t present.

If a label says “made in a tree nut free facility” that’s awesome. Here’s what that really means:

This product was made in a facility where tree nuts are not allowed. However, each raw ingredient does not necessarily fall under that statement.

In other words, if I source seeds from a facility that processes tree nuts, and bring it into my nut free facility, then there may still be trace amounts of tree nuts. This exact reason is why I choose to support allergy focused companies, as their ingredient sourcing tends to be superior to others. That’s not to say that others aren’t on their A-Game, more that allergy focused companies are always thinking about this type of stuff and keeping their customers safe is their absolute top priority.

As you call companies about their methods, you’ll learn that they all have different solutions in place to prevent cross-contact as much as possible with tree nuts and other major allergens. However, if a company isn’t being transparent with you, it may be better to find a similar product elsewhere.

Cross-Contact: What Is It?

Cross-contact, which some people incorrectly but also technically correctly call cross-contamination, is something everyone with a food allergy needs to know about. It’s important that you use the terms that are used in the food service and food manufacturing worlds, not how you’ll see people use it on the internet. If you don’t use it properly then try to communicate, professionals will be confused.

Cross-Contact: This refers to allergens specifically. If a chef uses a spoon in the dairy free sauce containing almond milk, then transfers the spoon to the nut free sauce to sample. In this case, a pathogen was not transferred because the dairy free sauce is cooked. An allergenic protein however was transferred.

Cross-Contamination: This refers to pathogens, bacteria, and food borne illnesses.

Example: a chef places raw chicken on a cutting board to prep it for service. After completion, raw celery which will be served raw is placed on the same cutting board. There’s contamination from the raw chicken and can cause a food borne illness via the celery that touched the board.

The issue with these terms is that *technically*, cross-contact is indeed cross-contamination. If you eat something contaminated with nuts, it causes a food borne illness in you. Yet, that’s where we have to focus on the terms pathogen and allergen. That will be the defining feature of these cross terms.

Now that you know the difference, make sure you use the right term when you communicate with companies and restaurants. Chefs and wait-staff especially will be confused if you use the wrong terms because they’ve been trained with pathogen vs allergen.

Through my work, I’ve met tens of thousands of people with food allergies. Whilst this isn’t an official stat or scientifically collected data, I’m able to estimate that about 30% of people with food allergies aren’t able to eat food that’s been made on shared equipment with what they’re allergic to. Keep that in the back of your mind if you seem to have “random reactions” even though you’re following a tree nut free diet (but still eating commercially produced foods).

If you’d like to read a lot more about cross-contact, all the ways it can happen, and how to prevent in your own home, check out this article.

If You Manage a Tree Nut Allergy and Have Severe Reactions, Call Companies

Tree nuts can be processed on the same equipment as so many packaged foods, and even bulk ingredients. It has a lot to do with manufacturing facilities and copackers. It’s not uncommon for seed, peanut, and chocolate facilities to also process tree nuts. Nuts have been known to be used as flavouring agents in alcohol as well, so drink carefully.

For those who can’t tolerate trace amounts of nuts, don’t try to get out of calling companies. Even a flour company needs to be called on the off chance they produce almond flour as well. Many beverage companies will need to be called as equipment is often shared with nuts. These days, everyone wants to add superfoods and energy dense ingredients to their beverages, many of which are nut based.

The kicker is: most small companies co-pack, meaning the equipment is shared with other manufacturers. Even if their product does not contain nuts, another company’s formula may contain tree nuts, and that’s where the larger risk lies.

As another example: If an ice cream company produces even one flavour with nuts, you’ll need to contact them to make sure it’s made on a separate line. Additionally, most bakeries process nuts in one way or another.

Steps to Take if You Have “Random” Reactions

I’ll tell you a true story to better illustrate this issue. One of my kids is allergic to milk and has severe reactions. When he was growing up, I was on top of everything, like a hawk, or so I thought. One day, after eating a milk free meal, he was incredibly sick and it looked like an allergic reaction, but I wasn’t quite sure. I only bought milk free products.

The reaction didn’t require medical intervention and we went on with life. The same thing happened a couple of weeks later and I pumped the brakes so dang hard we all had whiplash. I went through every packaged item in the home, and found that *one* product was processed on shared equipment with milk.

It’s how I learned the hard way that he was in the 30% group. I didn’t purchase a lot of products, and we had clean batches until that moment. After that, I made 95% of his food at home from scratch because the more companies I called, the more I was horrified to learn that even products like dairy free milk were made on shared equipment with milk. Of the things they don’t tell you when you’re first diagnosed.

So, if you find that you’re following a strict nut free diet, but are having random allergic reactions, start by eliminating foods processed on shared equipment with tree nuts. Next, check all of your bath and body products (soaps, toothpaste, lotions, etc.) and make sure nuts aren’t slathered all over your skin and scalp.

If you eliminate all shared equipment and are still having reactions, get your doctor involved. Ask for more testing to be done to make sure you haven’t developed a new allergy, or that you don’t have an underlying medical condition.

In the case of tree nuts, depending on the type of reactions you’re having, you may also want to ask about Oral Allergy Syndrome (now also called Pollen Food Allergy Syndrome) as many tree nuts are cross reactive with pollens.

Resources for the Newly Diagnosed

Newly Diagnosed eCourse for Food Allergy, Food Intolerance, and Restricted Diets

Diet Types & Cuisines

Most major cuisines will generally include nuts as an ingredient. When eating out, always ask to see an allergy menu. You should also call ahead and make sure they can serve you safely. A few years ago, a survey found that about 25% of wait-staff thought that by removing tree nuts from a salad, said salad was now nut free. Anyone with a tree nut allergy knows this isn’t true.

There will be menu items and dessert items that sound safe, but have tree nuts in them. So, as you attempt to eat out, make sure you’re speaking with a chef or manager, and you’re asking the right questions. One of the best tips I can give you is to also check out the Spokin app and the Allergy Eats app. One feature of both apps is that users submit reviews and tell you about their experiences at different locations.

Diet Types That Exclude Tree Nuts

Since these cuisines are naturally nut free, you may have better results eating at restaurants that are solely focused on these diet types. One of the biggest tips I can give you when you’re new to the diagnosis: if you’re looking for packaged foods, look for food products that claim to serve those diet types listed above as well.

Let’s Clear The Air on a Few Things About Nuts

Before we look at the list of tree nuts, I want to make sure you know the difference about a few things.

Peanuts are Legumes, not Tree Nuts
Tiger Nuts are Tuber Root Vegetables, not Tree Nuts
Sacha Inchi (aka Jungle Peanut) is a Seed, not a Peanut or Tree Nut
Pine Nuts are Seeds Officially, but most people accept them to be Tree Nuts
Nutmeg is Derived From the Seed of a Fruit
Coconut was previously classified as a tree nut for labeling laws, but is no longer treated as a tree nut.

List of Tree Nuts

Here’s a list of nuts as defined by the food labeling law with the U.S. FDA. Here’s what’s important to know: the FDA here in the U.S. says that only these tree nuts need to be called out in bold and included in the “contains” statement. Tree nuts outside of this list can appear like a regular ingredient, so make sure you’re reading labels very carefully if you need to avoid all tree nuts.

Almond (including Spanish Marcona Almond)
Black Walnut
Brazil Nut
California Walnut
Cashew
Hazelnut (Filbert)
Heartnut (Japanese Walnut)
Macadamia Nut (Bush Nut)
Pecans
Pine Nut (Pinon Nut)
Pistachios
Walnuts (English Walnut, Persian Walnut)

As of January 1, 2025, coconut will no longer be on the list of tree nuts to label for by the FDA.

Extended List of Tree Nuts

There’s a longer list of nuts to consider when we aren’t looking through the lens of the FDA. If you’re new to the diagnosis, I suggest printing out this tree nuts list (with the ones above as well) and keeping a copy in your car, a copy in your kitchen, and anywhere else it might be helpful. This can be very handy when reading food labels.

Acorn
Beech Nuts (also called beechnut)
Breadnut
Chestnuts
Karuka
Kola Nut (African)
Kurrajong (Australian)
Palm Nuts
Pili Nuts

Coconut is something you may or may not need to be on the look out for. Be sure to ask your doctor for advice on this matter. Water chestnuts are a tuber, not a true tree nut, but are still something you may want to avoid. Tiger nuts are tuber root vegetables with no relation to tree nuts. In fact, in my humble opinion, they’re a bit of a miracle ingredient for those who are allergic to both nuts and seeds.

These Foods Are Generally Made With/From Tree Nuts

As you shop and dine out, know that these food items are usually made with or from some type of tree nut.

Gianduja (also called Gianduia)
Marzipan
Nougat
Nutella
Pesto

Related Free Recipes on RAISE: Nut Free Pesto | Nut & Seed Free Nutella

Gluten Free, Dairy Free, Vegan, Nut Free Pesto Recipe by The Allergy Chef

Gluten Free, Nut Free, Seed Free, Top 9 Allergy Chocolate Spread by The Allergy Chef (Faux Nutella)

Almond Extract Isn’t Always From Almonds

Most producers of almond extract derive the extract from stone fruits such as peaches and apricots. You can call companies to learn more about this. However, there can be some cross-reactivity due to the shared botanical family. I’ve never met a person allergic to almonds who consumes almond extract derived from other fruits. The general consensus is to avoid the ingredient.

If this is something you’d like to try, ask your doctor if an oral challenge is a good idea for you.

Cross Reactivity: Cashews & Pink Peppercorns

There are four main types of peppercorns sold commercial: black, green, pink, and white. For those who are allergic to cashews, know that pink peppercorns are cross reactive with cashews. Pink peppercorn has been known to cause allergic reactions in those who have a cashew allergy.

Whilst the reaction is not guaranteed to happen, it’s advised that those with a cashew allergy avoid pink peppercorn. It’s an ingredient commonly seen in fine dining and high end packaged goods.

Pink peppercorn is sometimes to referred to as Brazilian Pepper, Rose Pepper, and Christmasberry. It’s not a true pepper, and considered part of the cashew family.

Cross Reactivity: Sumac & Tree Nuts

For those allergic to cashew and/or pistachio, there could be cross reactivity with sumac. Sumac is a popular Middle Eastern spice, and you may run into it whilst dining out at ethnic restaurants. Whilst research is essentially non-existent, know that they are related botanically, and a few reactions have been documented.

If you have cashew or pistachio allergies, be sure to ask your doctor about cross reactivity with other ingredients.

Hickory Connection

Be aware that there is a possible connection between hickory bark (commonly used for smoking foods) and a tree nut allergy. Hickory trees produce nuts, however, there aren’t any studies on the topic as of the time of this publishing. You can read a little bit more about this here.

Tree Nuts vs Peanuts

In a nut free nutshell, peanuts are a legume, and tree nuts are nuts from trees. It’s possible to be allergic to peanuts only, tree nuts only, or both. Remember, no two people are the same. However, if someone says something is “nut free”, they may or may not be including peanuts in that statement.

On the other hand, when someone says “peanut free”, they’re generally not referring to tree nuts as well. Make sure you always clarify this information before purchasing a product.

There’s a lot of incorrect language used around these two foods, mainly because peanuts are called peaNUTS. Those without food allergies make a reasonable assumption that they’re in the same group. Don’t let that frustrate you. Instead, be happy they’re even aware of food allergies to being with, something that wasn’t nearly as common even just ten years ago.

Hidden Sources of Tree Nuts

Hidden sources of nuts can include a very wide range of foods. Here are some of the places tree nuts hide in packaged foods.

Keto, Paleo, and Vegan foods are rely heavily on tree nuts. It’s one of the reasons I develop Paleo and Vegan recipes on RAISE that exclude nuts. For these diet types, tree nuts are seen as a great source of energy, and in some cases, a wonderful texture replacement.

Asian Foods commonly include tree nuts, sesame, and peanuts. Make sure you read labels carefully, and talk with a manager or chef before dining out. The exception tends to be sushi. There are little to no tree nuts in most sushi options.

Cereal and Granola can both contain nuts. In the case of cereal, there are a lot of nut free options available. However, if you have a severe nut allergy, you’ll need to make sure your cereals aren’t made on shared equipment with tree nuts. Two fantastic companies offering nut free solutions are Red Plate Foods and Zego Foods.

When Purchasing Chocolate, know that many brands offer at least one flavor that has nuts included. You’ll need to call to make sure they have a nut free line/equipment before purchasing. This article on allergy friendly candy has several nut free candy options.

Most Dairy Free Cheese on the market will contain coconut, almond, or cashew. For those who need top 9 allergy free + coconut free, you can create “cheese memories” at home using vegetables and nutritional yeast, or with amazingly flavored cream sauces.

Hiding in Plain Sight: As I mentioned in the list of tree nuts above, the FDA in the U.S. only requires some nuts be called out as major allergens. For the list of nuts that aren’t on the list, you’ll need to really read ingredient labels well to make sure those nuts aren’t present in your products.

Dairy Free Substitutes are loaded with tree nuts. Just about every tree nut has a milk option, and there are nuts in dairy free sour cream, dairy free cream cheese, dairy free yogurt, and dairy free ice cream. For those who are dairy free + nut free, look for “top 9 allergy free” here in the US and “top 14 allergy free” in the EU when shopping for dairy free products when you’re new.

Baked Goods and Desserts often contain tree nuts. Different varieties of tree nuts are used in vegan baked goods, gluten free baked goods, and wheat based baked goods. You’ll see nuts in cookies, cakes, and everything else that can be baked. Be sure to read labels carefully.

Coffee (different fancy drinks and flavors) can contain tree nuts. For those with cross-contact concerns, coffee shops use nut milks for dairy free consumers, and aren’t always aware of cross-contact when handling ingredients. In some cases, it may be better to bring your own milk and order a black coffee.

Tree Nuts In Personal Care Items

It’s not uncommon to find tree nut oils in shampoo, deodorant, and other personal care items. Walnut Oil, Coconut Oil, and Almond Oil are the three I see the most.

This website has an excellent list of oils that are derived from tree nuts, and oils that are nut free. When reading labels, you may not be aware that Argan Oil, Kukui Nut Oil, and Shea Butter are all derived from tree nuts.

Please remember that no two people are the same. There are some people online saying they’ve never reacted to these types of oils and that they’re safe for everyone. That couldn’t be further from the truth. Some people will react, so it’s important that you work with your medical team to have a better understanding of what could be a good fit for you.

Dining Out With a Tree Nut Allergy

Eating out at restaurants with a tree nut allergy is something you should avoid when you’re new. First, establish a neutral point and safe foods you can rely on. From there, call and check online before visiting a restaurant. Apps such as Allergy Eats and Spokin are created specifically for the food allergy community. Those apps are going to better at helping you than something like Yelp.

The apps will allow you to specify your allergies, which can be very helpful. Even if a restaurant has a positive review, you’ll still want to call and speak with a manager or a chef to ensure they can serve you properly.

Some menus will be more prone to cross-contact/contamination than others. For example, a restaurant that serves nut-crusted fish along with nut sauces, and almond slivers in the salads may have a higher chance for incident when compared to a sushi restaurant where the nuts my be in one particular sauce only.

Once you find a place that can serve you safely, embrace it and enjoy often.

Hidden Source of Nuts in Fine Dining & Traditional Pastry

Tree nuts can be found in some high end cocktails, and they’re all over the place in fine dining. Nuts are used as a garnish, in pastry creams, on salads, mixed into rice, and everywhere else you can think of.

Tree nuts are seen as a great option for adding texture and additional flavour to dishes, so make sure you communicate before purchasing or dining out. Make sure a restaurant can truly serve you safely.

Also, I don’t suggest eating at high end restaurants that have rotating menus. There are some that create a new tasting menu every week or two based on what’s local and in season. Whilst there’s something so exciting about that type of dining experience, it also means they’re less flexible for diners with food allergies because options are very limited.

Tree Nut Free Snacks To Check Out

There are a few brands that I want to call your attention to that make tree nut free snacks. You’ll want to always double check before purchasing, but last I checked, each of these products is made in a nut free facility.

Need nut free candy options? Check out this article on gluten free, nut free, and allergy friendly candy.

Additional Nut Free Resources

If you’re struggling with a nut allergy diagnosis, know that you aren’t alone. If tree nut free recipes are what you need, check out RAISE (my membership website). There are lots of great resources, and then there are well over 650 recipes, and just about all of them are nut free.

If you need more support, check out 1-on-1 Consulting with The Allergy Chef

Nut Butter and Peanut Butter Alternatives
Hidden Sources of Allergens (free eCourse, excellent information especially if you’re new to any food allergy diagnosis)
Nut Free Granola Bars & Breakfast Bars
Top 9 Allergy Free Lunch Ideas & Recipes

Have Hope!

Living tree nut free can be really hard at first, but it’s not impossible. Find allergy-focused brands that create foods you enjoy, and stick with them. Get creative in your kitchen and find substitutes that work for your family. If you’re dealing with more than a nut allergy, RAISE offers resources to meet the needs of people with multiple severe allergies (both major and less-common).

If you’re managing a child with food allergies, make sure you teach them young (when possible) how to manage their allergy so it becomes easy for them as they get older.

One final note: remember, living with food allergies isn’t the end of the world. I’m sure this article will leave some feeling overwhelmed, but I hope you see this as way to empower yourself. Yes, your life has changed, but, we’re living in a time where there are so many free-from options available. You’ve got this.

Answering Your Hidden Sources of Tree Nuts and Nut Allergy Questions

Do I have to do a food challenge?

A food challenge, sometimes called an oral challenge is entirely voluntary. Neither you nor your child have to do a food challenge if it makes you uncomfortable. Know that these are done under the supervision of your medical team, and they can intervene if there are signs of an allergic reaction.

I will say this: I’ve met adults who were put through countless food challenges and allergy tests as children. Their parents would test and test every year, and the child wouldn’t pass. They’ve told me as adults that they hated those tests and felt like a failure because they didn’t pass and their parents were disappointed.

Are all parents like that? No. Of course not. However, keep in mind that kids internalize things and if you’re constantly testing a child for food allergies, it can have a lasting effect on them.

Is there a nut allergy treatment option?

You’ll need to work closely with your doctor and allergist where treatment options are concerned. The main two treatments currently available are OIT and TIP. Let’s take a look at OIT, which has been around for years.

OIT (oral immunotherapy) is the process of exposing you to small amounts of a known allergen to build tolerance to said allergen. OIT is never guaranteed to work. In fact, when someone passes, we say they’re “in remission”, not cured, as there are no cures for food allergies. Know that results vary from one individual to the next because this is all a science of the immune system. Since no two people are the same, it’s impossible to predict 100% of the time how individuals will respond to OIT.

I’ve known of people who could never get pass the first OIT dose, and those who live in full remission. However, the thing about OIT that people don’t talk about enough is that just how you can gain tolerance, you can lose it as well. I’ve also met people in this boat where they passed OIT, then a few years later woke up one day and had a severe allergic reaction.

Additionally, those with EOE have a higher risk of developing more issues if they undergo OIT. This type of science is, in my opinion, poorly understood, and all you can do is do your best and work with the information you and your medical team have.

Really assess OIT and what it can do for you, and what your goals are. If the risk seems worth it, as an adult, I say go for it. If you’re managing a child, it’s different because of consent. It’s really important that they give fully informed consent before you introduce known food allergens to their system (something a lot of parents overlook). This is doubly true if your child has a complex case.

TIP is a form of OIT that’s more data driven. The doctors behind it looked at a lot of data to essentially create protein ladders. Let’s say someone is allergic to almonds. They won’t dose you to almonds first. Instead, they’ll dose you to 8 other foods that lead up to almonds due to protein structure and how they’re botanically related. The success rate for TIP is high, however, there are downsides as well.

In recent years, several patients have become very outspoken on the matter to make sure potential patients are seeing both sides of the coin. Ultimately, it’s your immune system, and if you think treatment is worth it, you should give it a try.

Does a nut allergy mean I’m allergic to nutmeg?

Despite the name, nutmeg isn’t a tree nut. Nutmeg is actually a seed, and if you’re allergic to seeds, you’d need to avoid it. Also know that mace is a derivative of nutmeg.

If I’m allergic to nuts do I need to avoid coconut as well?

That depends on your test results and immune system. I’ve met people who are allergic to botanical tree nuts only, all tree nuts, and a combination of one nut + coconut allergy. Anyone can be allergic to anything in any combination.

Let’s say you’re allergic to three tree nuts. Odds are, you’re going to be fine with coconut, but there’s no guarantee, and the only way to find out is via testing and/or an oral challenge. Mane sure you talk with your doctor/medical team about coconut, and if it would be a good ingredient for you to trial.

I have a nut allergy. Can I have almond extract?

Maybe. I spoke with a brand a couple of years ago that extracts their almond extract from apricot stones, rather than almonds. For some, this is an acceptable risk and they try that type of extract. For others, just on name alone, they would never give it a try.

I can’t personally say if you can have almond extract because almonds, pollens, and stone fruits are all related. There’s a chance you could react, and a chance you could be fine. Ask your doctor if it would be good for you to trial a stone fruit based almond extract.

Is it possible to purchase peanut butter not made on shared equipment with tree nuts?

Why yes it is! Last I checked, the brands Spread the Love and Crazy Richard’s Peanut Butter are making peanut butter in peanut only facilities. You’ll need to double check to make sure nothing has changed, but those are the best brands I can suggest.

Also, check out this article on spreads for more information and additional brands to investigate.

I have peanut, seed, and tree nut allergies. Is there any kind of nut butter substitute I can use?

Yup! My top suggestion for you will be tiger nut butter. Despite the name, tiger nuts aren’t tree nuts, they’re tubers. You can also look into soy butter and chickpea butter. However, make sure your peanut allergy hasn’t rendered you cross reactively allergic to other legumes. Both soy and chickpea are legumes as well.

Is dairy free gravy nut free?

Usually yes, however, you’ll want to read labels very carefully. As you venture into dairy free shopping, especially if you find yourself looking at Paleo packages, there are a lot of tree nuts involved (almond milk and cashew milk will be the top two offenders).

If you’re not able to tolerate trace amounts of tree nuts, make sure you get in touch with companies to make sure the equipment is nut free as well.

Are nut oils considered major allergens?

According to the FDA and some doctors, highly refined oils that have the allergenic proteins removed are no longer allergens. However, myself and many others have reacted to these exact oils.

In theory, if the tree nut proteins are removed, we shouldn’t be reacting to the item, however, every immune system is different. In terms of labeling laws, the FDA in the U.S. has a clause that if a highly refined oil can show that the proteins are removed, it doesn’t have to be in the contains statement.

The key is the amount of refinement. Some oils are sold as cold pressed and raw. Those oils absolutely have the proteins in tact and will have to be called out.

With oils not being called out, you’ll see this a lot with soy oil and a few others. What that means is you need to be extra vigilant if you plan on buying packaged foods or dining out if you’re like me and can’t have oils from what you’re allergic to.

Are tree nuts commonly used in protein powders?

Nut protein is a lot less common than say milk protein or pea protein in commercial applications. That doesn’t mean all protein powders are nut free, just that nuts are less commonly used.

If you’re new to protein powders, two brands I’d suggest are Zego Foods (top 9 allergy free, seed based) and Just Ingredients (organic, clean, generally allergy friendly).

Are ginkgo nuts tree nuts?

Whilst they aren’t popular in North America, they’re commonly seen in Japan, and are technically a seed. Specialty produce has quite the detailed write up on ginkgo nuts, and are worth a read if you’re considering harvesting them yourself.

Do soups commonly contain tree nuts?

Standard soups, stews, and chili won’t usually contain tree nuts. However, vegan and dairy free soup options are more likely to contain tree nuts. This is especially true if it’s something like butternut squash soup. Cashew is a common thickener in vegan and dairy free products, including creamy soups.

Are nuts commonly used in baby food and toddler foods?

As a super general rule, nuts aren’t commonly used in baby foods and toddler recipes. Now, that doesn’t mean baby food recipes etc. will be nut free. In fact, because of the LEAP study, we know about early introduction of allergens, and some recipes will include major allergens for this reason.

On the other hand, with the diagnosis rate on the rise, we’re living in a time where allergy friendly toddler snacks and the like are readily available. You should be able to find nut free baby food jars, snack pouches (applesauce etc.), and toddler friendly bars and puffs, all nut free.

Little Spoon is a great starting point for things like infant cereals and other baby foods, as they’re top 9 allergy free.