Nut Allergies: What Are They and How To Stay Safe

Food allergy is on the rise, affecting more than 32 million adults and children in the US, of which 10 million have peanut and tree nut allergies.

Key takeaways:
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    A food allergy is a life-threatening immune reaction and great care must be taken to avoid nuts and nut-containing products for those allergic.
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    Peanut allergy is more common than tree nut allergies. The most common tree nut allergy in the US is cashew, and hazelnut in the UK.
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    A peanut or tree nut allergy may occur suddenly, even in adults who have previously consumed a food regularly without issues. Some factors increase risk for development.
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    To ensure safety, it’s best to avoid products with listed and cross-contamination allergens. Some experts advise avoiding all tree nuts. Research and planning is often necessary to avoid foods with high risk of nut ingredients.

What is a food allergy?

A food allergy is a serious and often rapid immune response to a food antigen – a protein within a specific food – involving IgE antibodies and systemic symptoms such as anaphylaxis, swelling, difficulty breathing, dizziness and digestive disturbances. Other parts of the immune system may also be involved as in the case of allergic-immune eosinophilic gastrointestinal diseases. A food allergy is potentially life-threatening unlike a food sensitivity or intolerance, though both may contribute to uncomfortable or difficult-to-manage symptoms. Those with asthma are at higher risk of severe reaction to food allergens.

Which nut allergy is most common

FARE – Food Allergy Research and Education - reports the prevalence of peanut or tree nut allergy has more than tripled in children in the last few decades, and comprises two of the top four allergens in children, as well as adults. Milk and shellfish are the other two top allergens.

Peanuts are technically a legume related to beans and peas and are different from tree nuts. Peanut allergies are more common, affecting 6.1 million adults and children, while tree nut allergies affect 3.9 million.

Common tree nuts include almonds, pecans, walnuts, pistachio, cashews, Brazil nuts, beechnuts, hazelnuts, macadamia nuts, pine nuts, and pili nuts. Prevalence of tree nut allergies varies by region of the world. The most common tree nut allergy in the US is cashew, closely followed by walnut, whereas hazelnut is the most common tree nut allergen in Europe, and Brazil nut, almond and walnut in the UK.

Can a nut allergy occur suddenly?

While food allergies most often first occur in young children, a food allergy can develop suddenly in adulthood. Though not all risk factors are clearly defined, it appears environmental allergies such as birch pollen, other food or tree nut allergies, compromised intestinal permeability or leaky gut, and asthma may contribute to sudden allergy onset. In fact, 70% of those who are allergic to birch pollen are allergic to hazelnuts, apple, carrot, and/or celery.

Allergen avoidance: what is the best practice

Avoidance of the diagnosed allergen in every form is recommended and required to ensure safety. Labels must declare if they contain the top eight allergens - milk, soy, wheat, peanuts, tree nuts, fish, shellfish, and egg – easing grocery shopping and product selection burdens. In addition, labels must claim the type of nut present.

Unfortunately, even if a product does not contain listed allergens, it may be contaminated with allergens during the manufacturing or handling process, known as cross-contamination. Though not required, some brands and products choose to voluntarily provide one of two cross-contamination label statements:

  • May contain...
  • Manufactured in a facility that also processes...

What foods to check/avoid that may contain nuts

FARE reports that most food allergy reactions occur outside of the home, so caution and planning are paramount to avoid reactions. While it may seem obvious how to avoid whole peanuts or tree nuts, peanuts, and tree nuts are common ingredients in many manufactured, processed, and restaurant-prepared foods. Practice caution by checking labels and speaking with the manufacturer to better understand your risk of consumption with the following foods:

  • Alcoholic beverages.
  • BBQ sauces.
  • Candy.
  • Chocolate and products containing chocolate.
  • Cereals.
  • Cookies.
  • Crackers.
  • Energy bars.
  • Flavored coffees.
  • Frozen desserts.
  • Marinades.
  • Non-dairy milks, ice creams, and cheeses.
  • Salad dressings.

Peanuts and some tree nuts - cashew, walnut, and hazelnut - represent some of the most common food allergens. These foods are often present as ingredients in packaged, processed, and restaurant-prepared foods. Cross-contamination may also occur. Many experts recommend those with tree nut allergies avoid all tree nuts, though speak with your doctor for an individualized approach.

With awareness, planning and caution, you can reduce your chances of exposure and consumption and therefore your risk of a severe reaction.

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