Tree Nut Allergy Diet
The only treatment for people with food allergies is to avoid the food. Tree nut allergy is one of
the top 8 food allergies in the United States.
Tree nut allergy can be very dangerous. Tree nut proteins may be in foods that you may not
expect. Read food labels well and remember that products may change ingredients without
warning. Always check and recheck all foods, even the “safe” foods you have bought before.
When you eat in a restaurant, explain the restriction clearly to the manager and wait staff, so the
food is not cooked or cross-contaminated with tree nuts.
The Food Allergen and Consumer Protection Act of 2004 requires that foods must list
ingredients by their common names for the top 8 allergenic foods. The top 8 allergenic foods in
the United States are eggs, milk, soy, wheat, peanut, tree nuts, fish, and shellfish.
These ingredients show that the tree nut protein is present:
ξ Almond, almond paste
ξ Brazil nuts
ξ Hazelnuts (also called
filberts or cobnuts)
ξ Lichee nut
ξ Gianduja (mixture of
chocolate and chopped
nuts in imported
ξ Hickory nuts
ξ Macadamia nuts
ξ Artificial nuts
ξ Nut butters (cashew,
almond, pistachio, etc)
ξ Nut Oil
ξ Nut paste
ξ Pine nuts (pignolia,
ξ Ginko nut
ξ Nangai nuts
ξ Nut meal or nut meat
ξ Shea nut, also known
**Coconut, has not been restricted in the diets of people with tree nut allergy. Yet, in October
of 2006, the FDA began to identify coconut as a tree nut. There have been a small number of
allergic reactions to coconut. Most of these reactions though occurred in people who were not
allergic to other tree nuts. Ask your doctor if you need to avoid coconut.
These ingredients may show that tree nuts are present:
ξ Natural extracts, such as almond extract
ξ Barbeque sauces
ξ Ice creams
ξ Chocolate Candies
ξ Cereals or crackers
ξ Ground nuts
ξ Ethnic dishes
Breads Bread products made
without tree nuts.
Any bread, biscuits,
doughnuts, muffins, rolls,
etc. with tree nuts.
Candies Candy without tree nuts. Any candy or candy bar
with tree nuts OR that is
produced on the same
equipment as tree nut
Desserts Desserts made without tree
Any dessert made with tree
nuts or nut products. Read
labels on commercial
Fats and oils All fats and oils where there
is not a risk of cross
contamination or presence
of tree nut protein
Oils or fats that may be
cross contaminated with tree
nuts or reused
Fruits All fruits. Fruit cake with tree nuts or
salads that may contain tree
nuts (example Waldorf
Meat and meat substitutes All meats, soy nut butter. Chinese, Thai foods and
other Asian foods prepared
with nuts. Tree nut butters
like almond or cashew
butter, egg rolls. Marinated
or breaded meats with tree
nuts Mandelonas, and tree
Milk, cheese and dairy
All milk, cheese and eggs. Flavored yogurts containing
tree nuts or dairy substitutes
like almond milk
Potatoes and pastas Potatoes, rice, noodles,
macaroni and pasta not
prepared with tree nuts.
Asian noodles cooked with
Seasonings All spices and herbs.
Marinades that contain tree
Soups Soups without nuts or nut
Soups prepared with tree
nuts or tree nut butters, such
as almond butter or almond
Sweets All sugars; honey, jam, jelly
Frostings made with tree
Vegetables Vegetables prepared without
Cautions and tips
1. Avoid all foods that are made on equipment shared with other nuts. Avoid foods made in
the same place where food products with tree nuts are made. There is a risk of cross
2. Although an allergy to tree nuts is fairly common, some people are very sensitive. Carry
all medicines, including the Epi-pen, if you are traveling or away from home.
3. People who are allergic to tree nuts are sometimes allergic to peanuts as well. Check
with your doctor to confirm which nuts you need to avoid. See info on cross-reactivity,
4. Seeds and other products are often processed at the same location as peanuts or tree nuts.
If you are unsure and the label doesn’t state this, call the food company for more
information. Some companies have separate facilities for their tree nut foods, but some
do not. Examples include M & M candies or Jelly Belly jellybeans.
Tips to follow to prevent an allergic reaction
ξ Avoid foods that cause a reaction. Sometimes just touching foods can cause a severe
reaction. Parents, caregivers and even siblings need to wash hands after eating to avoid
causing a reaction with food particles.
ξ Read the ingredients lists on food labels to make sure foods that cause allergies are not
present. Read the list even if you have had the product before. Ingredients may change.
ξ If you are traveling, bring along some of your own special foods.
ξ When you eat out, always ask restaurant staff about ingredients in food and how it was
prepared. Some cooking oils can have allergens. When in doubt, do not eat it.
ξ For infants, elemental formulas or formulas with altered protein should prevent food
reactions. Talk about the formula options with your doctor or dietitian. Do not assume
products labeled "hypoallergenic" will not cause a reaction.
ξ When you cook clean counters, utensils and pans that have had tree nuts in or on them.
For some people, even touching something that had nuts on it that was not cleaned well,
will cause a reaction.
Cross reactivity is when the proteins in one food are similar to the proteins in another food.
Sometimes the body’s immune system sees both proteins as similar to each other. Tree nuts are
not in the same family as peanuts. About 35% of peanut-allergic toddlers will have or develop a
tree nut allergy.
Sometimes doctors will tell you to avoid all tree nuts if allergic to peanuts. Other times doctors
can figure out which tree nuts a child is allergic to, so they can eat certain nuts, but not others.
There is a high degree of cross reactivity with cashew and pistachio and also between walnut and
pecan. Be sure to check with your doctor to figure out which tree nuts to avoid.
Food Allergy and Anaphylaxis Network www.foodallergy.org or 1-800-929-4040
Food Allergy Foundation www.foodallergyfoundation.org
Asthma and Allergy Foundation of America www.aafa.org
American Academy of Allergy Asthma and Immunology www.aaaai.org (there is a great section
called “Just for Kids” that has great tips, information, ideas and recipes)
Kids With Food Allergies: http://www.kidswithfoodallergies.org (this site has a great recipe
Food Allergy Association of Wisconsin- http://foodallergywis.org/ or 608-575-9535
What is the most important thing you learned from this handout?
What changes will you make in your diet/lifestyle, based on what you learned today?
If you are a UW Health patient and have more questions please contact UW Health at one of the
phone numbers listed below. You can also visit our website at www.uwhealth.org/nutrition.
Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s
Hospital (AFCH) can be reached at: (608) 890-5500.
Nutrition clinics for UW Medical Foundation (UWMF) can be reached at: (608) 287-2770.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 10/2016 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Clinical Nutrition Services Department and the Department
of Nursing. HF#579