Table of ContentsView AllTable of ContentsOverviewSymptomsRisk FactorsTypes of Tree NutsAllergies to More Than One Tree NutFoods Made With Tree NutsDiagnosisEating OutFood Labeling LawsFrequently Asked Questions

Table of ContentsView All

View All

Table of Contents

Overview

Symptoms

Risk Factors

Types of Tree Nuts

Allergies to More Than One Tree Nut

Foods Made With Tree Nuts

Diagnosis

Eating Out

Food Labeling Laws

Frequently Asked Questions

In the United States, about one in every 200 people have a tree nut allergy, making it one of the most common food allergies amongst both adults and kids.

While most tree nut allergies start in childhood, it is possible develop a tree nut allergy when you are older.Only about 10% of people end up outgrowing their allergy over time.

Tree nuts—almonds, cashews, walnuts, and others—often cause strong allergic reactions. In some cases, these can be life-threatening. People who have an allergy to one type of tree nut often also have allergies to others.

Those severely allergic may not only need to avoid the nuts and products made with them, but also things prepared or packaged in the same facilities that process them.

This article explains the symptoms of tree nut allergies and how they are diagnosed. It also provides a tree nut list and details many of the foods that may contain tree nuts.

What Is Tree Nut Allergy?

A variety of proteins in tree nuts are the allergens that cause reactions in persons with tree nut allergies. Some people have allergies to one protein while other people have allergies to other proteins in tree nuts. The protein(s) that a person is allergic to will determine whether a person needs to avoid just one nut or more than one type of nut.

Most people with tree nut allergies will have them for their lifetime.

RecapTree nuts are one of the most common causes of food allergy in adults and children. If you have an allergy to tree nuts, your immune system responds to them as if they are harmful. This leads to symptoms of allergic reaction.

Recap

Tree nuts are one of the most common causes of food allergy in adults and children. If you have an allergy to tree nuts, your immune system responds to them as if they are harmful. This leads to symptoms of allergic reaction.

How Your Immune System Works

Symptoms of Tree Nut Allergy

There are many symptoms of a tree nut allergy. Some occur when you consume the nut or something that has even just particles from one. Sometimes, people can develop a rash when their skin is exposed to tree nuts, particularly to tree nut butters.

They are likely to vary from person to person, but you will likely experience at least some of the following:

Tree nut allergy symptoms may occur right away or be delayed for up to a couple of hours. In the event of anaphylaxis, symptoms should be treated immediately. Less severe symptoms that are limited to the skin only or merely involve itching may resolve on their own.

What Is Anaphylaxis?Anaphylaxis is a life-threatening allergic reaction. Sudden symptoms can affect the whole body as the immune system overreacts to tree nuts or other allergens. This can cause your blood pressure to drop, interfere with breathing as your airway swells and closes, and cause the body to go intoshock. If this happens, use your injectable epinephrine (Epi-pen) and call 911 immediately

What Is Anaphylaxis?

Anaphylaxis is a life-threatening allergic reaction. Sudden symptoms can affect the whole body as the immune system overreacts to tree nuts or other allergens. This can cause your blood pressure to drop, interfere with breathing as your airway swells and closes, and cause the body to go intoshock. If this happens, use your injectable epinephrine (Epi-pen) and call 911 immediately

Symptoms of Anaphylaxis

Risk Factors of Tree Nut Allergy

There are quite a few reasons why a person may be more at risk of developing a tree nut allergy.

Exposure to environmental factors like air pollution or chemicals may contribute to the likelihood that you’ll develop a new allergy.Your genes and family history also play a role in the likelihood that you develop tree nut or other allergies.

Studies suggest there also may be links between tree nut allergies and the development of other medical conditions, including eczema and severe asthma.

RecapSome people may be more at risk for tree nut allergies than others. Environmental factors and a family history of allergies may play a role. Some studies suggest links between tree nut allergies and other medical conditions, such as asthma.

Some people may be more at risk for tree nut allergies than others. Environmental factors and a family history of allergies may play a role. Some studies suggest links between tree nut allergies and other medical conditions, such as asthma.

There are many different types of tree nuts found across the world.

Among the more common tree nuts that you’re likely to have eaten are:

Botany lovers will note that some on this list are not true nuts, according to the scientific definition. However, they are all grouped under the tree nut umbrella because they come from trees. Some can trigger an allergy. (This is perhaps also because most people can’t tell a true nut from a lookalike.)

Other tree nuts, used less often, include beechnuts, butternuts, chinquapins, gingko, hickory nuts, lychee nuts, and pili nuts. Shea nuts, which grow on the African shea tree, are not always considered a tree nut but—as with coconuts—the FDA requires manufacturers to label them as such.

A Word About Peanuts

Peanutsare grown in the ground and are legumes, which are unrelated to tree nuts.

A tree nut allergy does not mean you automatically have apeanut allergy. However, it is possible to have both of these distinct conditions. About 30% of people who are allergic to tree nuts also react to peanuts.

Even if you’re not allergic to peanuts, they can still pose a problem if you have tree nut allergies because of their high risk for cross-contamination. Tree nut proteins may find their way onto peanuts because they are processed in the same manufacturing plant. These nuts are also often mixed together in food products.

Because of the risk of allergic reaction, people with severe tree nut allergies may consider avoiding products that mention the possibility of tree nut cross-contamination on labels. Regardless of a person’s choice to avoid or consume products with possible cross-contamination, people with a severe tree nut allergy should carry an epinephrine auto-injector to use in the event of anaphylaxis after accidental exposure.

Is Coconut a Tree Nut?Coconutis a fruit that grows on palm trees. It is not a nut, despite the fact that the U.S. Food and Drug Administration (FDA) requires that it be labeled as such.Coconut allergyis rare and most people with tree nut allergy do not need to avoid coconut.

Is Coconut a Tree Nut?

Coconutis a fruit that grows on palm trees. It is not a nut, despite the fact that the U.S. Food and Drug Administration (FDA) requires that it be labeled as such.Coconut allergyis rare and most people with tree nut allergy do not need to avoid coconut.

How to Avoid Cross-Contact with Tree Nuts

If you are allergic to one tree nut, it does not mean you’re allergic to all of them. In fact, most people aren’t.

However, reactions to more than one type of tree nut are not uncommon. Australian researchers have found that 30% of children ages 10 to 14 who have an allergy to one tree nut also have an allergy to at least one more.

This is because tree nuts can contain similar problematic proteins. This is true of almonds and hazelnuts, walnuts and pecans, as well as pistachios and cashews.

Children who are allergic to more than one or two tree nuts are less likely to outgrow their allergies.For this reason, healthcare providers recommend that children with tree nut allergies be periodically reassessed to see if or how a tree nut allergy has changed over time.

RecapThere are many types of tree nuts and products made with them. You may be allergic to one or more types. In some cases, because proteins in some nuts are similar, it may be likely that you’ll be allergic to these common types. Peanuts arenota tree nut, but you can have allergies to both or to products made with mixed nut types.

There are many types of tree nuts and products made with them. You may be allergic to one or more types. In some cases, because proteins in some nuts are similar, it may be likely that you’ll be allergic to these common types. Peanuts arenota tree nut, but you can have allergies to both or to products made with mixed nut types.

Tree nuts are used in a variety of foods—some obvious, some perhaps not.

For example, milks like almond milk and main dishes like chicken with cashew sauce very clearly contain tree nuts.

But tree nuts are also often ingredients in baked goods, ice cream, cereals, sauces, and other manufactured products. You might only know they are there after reading the food label or asking the baker.

Some of the foods that always (or almost always) have tree nuts as ingredients include:

Is Almond Extract Safe if You Have Nut Allergies?

There are many other foods that may contain tree nuts. They may include:

As with many common allergens, tree nuts are sometimes found in unlikely foods. This list does not include them all, so be sure to read labels on all packaged foods before buying or eating them.

How Tree Nut Allergies Are Diagnosed

A healthcare provider can diagnose a tree nut allergy based on factors like the kinds of symptoms you have, when they occurred, and how severe they are. It’s likely that you’ll want to see aboard-certified allergistwho specializes in food allergies.

They’ll use this and other information, such as your family history and any other medical conditions you have, to begin an evaluation for tree nut allergy.

You may be asked to keep a food diary to record what you’ve been eating and what kinds of symptoms may follow.

You also may be asked to try anelimination diet, and remove tree nuts for two weeks. You’ll watch for changes in your symptoms to identify if the tree nut is the cause, and then add them back into your diet to see if your symptoms return.

Blood tests are usually used to confirm a diagnosis of food allergy after reviewing a patient’s history. These measure specific IgE to the food allergens of concern. Skin prick tests may also be used to confirm a diagnosis.

RecapA healthcare provider can help to diagnose a tree nut allergy for you or your child. They will likely begin with a detailed medical history and ask questions about your symptoms. You may be referred to an allergy specialist. A skin prick test may be used to aid in the diagnosis of food allergy at the allergist’s office.

A healthcare provider can help to diagnose a tree nut allergy for you or your child. They will likely begin with a detailed medical history and ask questions about your symptoms. You may be referred to an allergy specialist. A skin prick test may be used to aid in the diagnosis of food allergy at the allergist’s office.

How to Try an Allergy Elimination Diet

Eating Out With Tree Nut Allergies

There are some places where it may be difficult to avoid tree nuts. For example, you may attend parties or gatherings where bowls of mixed nuts may be served or you’re not sure how foods were prepared.

In restaurants, it may be hard to find out which dishes contain tree nuts and which ones don’t. Don’t rely on the menu; ask about the ingredients in whatever you’d like to order.

Cuisines that may use nuts include:

Restaurants also may usetree nut oilsto make marinades and salad dressings.

That said, the risk of a dangerous allergic reaction is still there. For example, foods containing tree nuts may be prepared on the same surface as the nut-free dish you order. Make sure your server is aware of your tree nut allergy so this can be avoided.

What the U.S. Food Allergen Labeling Law Really Requires

Tree Nuts and Food Labeling Laws

The law does not require that the labeling language be the same on every product, or that the messaging be placed in a specific location on the label. So, while you may find a prominent “tree nut-free” icon on the front of one product, another may have a simple line of text somewhere under the nutritional facts.

Although FALCPA also does not require manufacturers to report if a food is made on a production line that also processes tree nuts or products that contain them, many companies do voluntarily.

Whether the law will be amended to address these things is to be seen. However, it’s possible that manufacturers may not wait given the strong and growing consumer demand for clearer, more consistent food allergen labeling.

If you or your child have a tree nut allergy, be sure that you know how to read product labels well. You’ll also want to know the symptoms of severe food allergies and how they are treated.

Summary

Tree nuts are one of the top causes of food allergy. They evoke an immune system response that leads to symptoms of allergic reaction in some people, including a tightening throat, lip swelling, and hives.

Symptoms can get to the point where they are severe enough to cause anaphylaxis, a body-wide, life-threatening reaction. Use your epinephrine injector and call 911 right away.

There are a number of possible factors that raise the risk for tree nut allergies, including family history. In many cases, tree nut allergies will last a lifetime. You’ll need to know how to avoid the tree nuts that cause your allergic reactions and read product labels carefully.

A Word From Verywell

Keep in mind that if your child has a tree nut allergy, teachers and other adults in their life will need to know. You’ll want to be sure your child knows how to avoid tree nuts too.

For adults, be sure that someone knows where you keep your epinephrine injector so they can help you if needed.

Yes. They are among the top reasons for why you may have a food allergy. The others are milk, soy, egg, wheat, peanuts, fish, and shellfish.Learn MoreA Guide to the Most Common Food Allergies

Yes. They are among the top reasons for why you may have a food allergy. The others are milk, soy, egg, wheat, peanuts, fish, and shellfish.

Learn MoreA Guide to the Most Common Food Allergies

It’s possible, but in most cases, a tree nut allergy diagnosed in childhood will not go away. This means that your child will need periodic check-ups to evaluate their tree nut allergy.Learn MoreFood Allergies in Children

It’s possible, but in most cases, a tree nut allergy diagnosed in childhood will not go away. This means that your child will need periodic check-ups to evaluate their tree nut allergy.

Learn MoreFood Allergies in Children

Unfortunately, yes. Anaphylaxis is a life-threatening allergic reaction that requires immediate action. The good news is that you can take steps to prevent these reactions, such as reading labels carefully and avoiding problematic tree nuts. You should also always keep an epinephrine auto-injector on hand to use in the event of anaphylaxis; this medication when used appropriately can be life-saving.

No. Some foods like butternut squash have “nut” in their name but do not contain any nut proteins. They are safe to consume. Also, most people only need to avoid one or two nuts and not all nuts in general.

17 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Mandalari G, Mackie AR.Almond Allergy: An Overview on Prevalence, Thresholds, Regulations and Allergen Detection.Nutrients. 2018;10(11):1706. doi:10.3390/nu10111706

American College of Allergy, Asthma, & Immunology.Food Allergies: Can a nut allergy develop after the age of 40?

American College of Allergy Asthma & Immunology.Everything You Need to Know About Tree Nut Allergy.

Weinberger T, Sicherer S.Current perspectives on tree nut allergy: a review.J Asthma Allergy. 2018;11:41-51. doi:10.2147/JAA.S141636

Kashyap RR, Kashyap RS.Oral Allergy Syndrome: An Update for Stomatologists.J Allergy (Cairo). 2015;2015:543928. doi:10.1155/2015/543928

Australasian Society of Clinical Immunology and Allergy.Allergic Conjunctivitis.

Takano H, Inoue KI.Environmental pollution and allergies.J Toxicol Pathol. 2017;30(3):193–199. doi:10.1293/tox.2017-0028

Bønnelykke K, Sparks R, Waage J, Milner JD.Genetics of allergy and allergic sensitization: common variants, rare mutations.Curr Opin Immunol. 2015;36:115–126. doi:10.1016/j.coi.2015.08.002

Bager J, Tedner SG, Andersson N, Ballardini N, Borres M, Konradsen J, et al.Prevalence and early‐life risk factors for tree nut sensitization and allergy in young adults.Clin Exp Allergy. 2021;51(11):1429-1437. doi: 10.1111/cea.13994

Food & Drug Administration.FDA Basics for Industry.

American Academy of Allergy, Asthma & Immunology.Everything You Need to Know about Tree Nut Allergy.

Warren CM, Sehgal S, Nimmagadda SR, Gupta R.Prevalence and burden of coconut allergy in the United States.Ann Allergy Asthma Immunol. 2023 Nov;131(5):645-654.e2. doi:10.1016/j.anai.2023.08.017

Weinberger T, Sicherer S.Current perspectives on tree nut allergy: a review.J Asthma Allergy. 2018;11:41–51. doi:10.2147/JAA.S141636

McKinsey & Company.Consumers with food allergies: A growing market remains underserved.

Manea I, Ailenei E, Deleanu D.Overview of food allergy diagnosis. Clujul Med. 2016;89(1):5-10. doi: 10.15386/cjmed-513

American College of Allergy, Asthma, & Immunology.Tree nut allergy.

Joneja, Janice Vickerstaff. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and DIetetics.Sicherer, Scott. Food Allergies. A Complete Guide for Eating When Your Life Depends on It. The Johns Hopkins University Press. Baltimore, MD.

Joneja, Janice Vickerstaff. The Health Professional’s Guide to Food Allergies and Intolerances. Academy of Nutrition and DIetetics.

Sicherer, Scott. Food Allergies. A Complete Guide for Eating When Your Life Depends on It. The Johns Hopkins University Press. Baltimore, MD.

Meet Our Medical Expert Board

Share Feedback

Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit

Was this page helpful?

Thanks for your feedback!

What is your feedback?OtherHelpfulReport an ErrorSubmit

What is your feedback?