General guidelines for tree nut allergy

The key to an allergy-free diet is to stay away from all foods or products containing the food to which you are allergic. If you have an allergy to tree nuts, you need to stay away from foods that have tree nuts. To prevent allergic reactions, you must read food labels.

By law, all packaged food items in the U.S. must clearly state on their label if they contain tree nuts. And the type of tree nut must also be listed on the food label. This is required by the Food Allergen Labeling and Consumer Protection Act (FALCPA).

Peanuts are different than tree nuts. Some people with tree nut allergy are also allergic to peanuts, while others are not. Additionally, some people with a tree nut allergy must stay away from all tree nuts (listed below). Others may be able to eat some types of tree nuts but not have others. Talk with your healthcare provider about what's right for you.

How to read a label for a tree nut-free diet

Stay away from the following nuts:

• Almonds

• Beechnuts

• Brazil nuts

• Butternuts

• Cashews

• Chestnuts

• Coconut

• Filberts or hazelnuts

• Gingko nuts

• Hickory nuts

• Lychee nuts

• Macadamia nuts

• Pecans

• Pine nuts (pignolia)

• Pistachios

• Walnuts

Stay away from the following foods, as they often contain tree nuts:

• Caponata (seafood salad with pine nuts)

• Gianduja (mixture of chocolate and toasted nuts in premium or imported chocolate)

• Marzipan/almond paste

• Natural nut extract

• Nougat

• Artificial nuts

• Nut butters (for example, cashew or almond butter)

• Chocolate Hazelnut spread

• Nut oil

• Nut pastes (for example, almond paste)

• Pesto (may be made with pine nuts, walnuts, or cashews)

• Praline

Also keep in mind:

• Don't eat artificial nuts. They are peanuts that have been deflavored. They are reflavored with a nut such as pecan or walnut.

• The FDA classifies coconut as a tree nut, but it's actually a fruit. Many people who are allergic to tree nuts can eat coconut safely. Ask your healthcare provider if it's safe for you to eat coconut.

• Shea nuts are also listed as a nut by the FDA; however, shea nut allergy is rare. Ask your healthcare provider if it is safe for you to use shea nut or use products with shea nut butter.

• Don't eat foods with natural extracts, such as pure almond extract and natural wintergreen extract.

• Ethnic foods, commercially prepared baked goods, and candy can be cross-contaminated with nuts.

• Tree nuts are added to many types of foods. These include barbecue sauces, cereals, crackers, and ice creams.

• Foods that don't contain tree nuts can be contaminated during manufacturing. And companies are not required by law to put advisory statements on food labels. Advisory statements include things such as "made in a facility with tree nuts" or "made on shared equipment." Ask your healthcare provider if you can eat products with these labels.

• Some foods and products are not covered by the FALCPA labeling law. These include:

  • Foods that are not regulated by the FDA

  • Makeup and personal care items

  • Prescription and over-the-counter medicines and supplements

  • Toys, crafts, and pet foods

When you are not at home

• Always carry 2 doses of epinephrine medicine, such as epinephrine autoinjectors or nasal spray. Make sure that you and the people close to you know how to use them.

• Wear a medical alert bracelet or necklace with your allergy information.

• If you don't have epinephrine, talk with your healthcare provider. Ask if you should carry it.

• In a restaurant, keep in mind that food may be cross-contaminated with tree nuts. Tell your server that you have an allergy.

• Always read food labels. And always ask about ingredients at restaurants. Do this even for foods that you have eaten before.

• Don't eat at buffets that have tree nuts. Food at these buffets can be contaminated by shared serving spoons.