Tree Nut Allergy Diet Guide

Bowls of various nuts

Verywell / Zorica Lakonic

Tree nuts are a common food allergy: in the United States, about 0.5% of the population—or about one in every 200 people—is allergic to tree nuts. Tree nuts frequently cause strong allergic reactions and may cause anaphylaxis, which is a potentially life-threatening allergic reaction.

It's possible to be allergic to just one type of tree nut, but many people are allergic to multiple different types of tree nuts. In addition, it's common for food manufacturers to process different types of tree nuts on the same equipment, raising risks for people who are allergic. Therefore, if you have a tree nut allergy, your healthcare provider may warn you to avoid most or all tree nuts.

Types of Tree Nuts

The most common tree nuts include macadamia nuts, brazil nuts, cashews, almonds, walnuts, pecans, pistachios, chestnuts, hazelnuts (filberts), and pine nuts (pignoli or pinon). Less common tree nuts include beechnuts, butternuts, chinquapins, gingko, hickory nuts, lychee nuts, pili nuts, and shea nuts.

The majority of individuals with a tree nut allergy will have it for their lifetime. Research indicates about 9% of children who have a tree nut allergy will outgrow that allergy. For this reason, healthcare providers recommend that children with allergies to tree nuts be reevaluated periodically by a ​board-certified allergist to see if they've outgrown the allergy.

Children who are allergic to multiple types of tree nuts (more than one or two) are less likely to outgrow their allergy than children who are allergic to just one type of tree nut.

Allergies to More than One Nut

People can be allergic to one type of tree nut, to some tree nuts, or many tree nuts.

Some tree nuts contain similar proteins—for example, almonds and hazelnuts contain similar proteins, as do walnuts and pecans, and pistachios and cashews. Because of these protein similarities, it is common for an individual to have an allergy to more than one type. For instance, if you are allergic to cashew, you have a higher risk of being allergic to pistachios, as well.

Most people who have a tree nut allergy are not allergic to all tree nuts. The decision to avoid all tree nuts when you have an allergy to one or more is an individual choice that you should discuss with your healthcare provider.

Allergy to Both Tree Nuts and Peanuts

Peanuts are legumes and are biologically unrelated to tree nuts. Tree nut allergy and peanut allergy are two different types of allergies. Still, while people allergic to tree nuts are not necessarily allergic to peanuts, it's also possible be allergic to both.

You should be aware that tree nuts and peanuts are often found together in processed foods and nut mixtures. If you are diagnosed with a tree nut allergy, your allergist will advise you whether to avoid peanuts, as well.

Symptoms Associated With Tree Nut Allergy

Your symptoms can experience a variety of symptoms after eating tree nuts, but you are unlikely to experience all of them. The symptoms can begin while you are eating the nuts or they may start afterwards—usually within one day of eating the nuts.

For some people, symptoms resolve quickly on their own, and serious symptoms may require medical treatment.

Symptoms associated with a tree nut allergy include:

  • Tingling lips
  • Itching mouth, ears, and eyes
  • Oral allergy syndrome
  • Contact dermatitis
  • Throat tightening
  • Urticaria (hives)
  • Angioedema
  • Conjunctivitis
  • Worsening asthma symptoms
  • Abdominal pain
  • Diarrhea
  • Vomiting
  • Anaphylaxis

People who have a tree nut allergy should carry a source of epinephrine at all times in case they have a life-threatening allergic reaction or anaphylaxis. You can develop these serious issues even if your allergy symptoms have only been mild in the past.

Tree Nuts and Food Labeling Laws

Tree nuts are among the most common food allergies, and as such, the U.S. Food and Drug Administration requires manufacturers selling foods in America to label foods containing tree nuts. The Food Allergy Labeling and Consumer Protection Act (FALCPA) requires that manufacturers label which tree nut is in a given product.

Manufacturers are not required to mention the presence of tree nuts on manufacturing lines. Many do, however. Because of the possibility of anaphylaxis, people with tree nut allergies should avoid products that mention the possibility of tree nut cross-contamination on labels.

Remember to always read your food packaging and ingredient labels, since ingredients and manufacturing practices can change at any time.

Foods That Contain Tree Nuts

Food that always or almost always contains tree nuts include:

  • Nutella (made from hazelnuts)
  • Marzipan (almond paste)
  • Pesto (unless specially prepared without pine nuts)
  • Baklava
  • Pralines
  • Nut liqueurs (Frangelico, Amaretto, and Nocello)
  • Nougat
  • Turrón (a candy typically made with almonds)
  • Gianduja (a creamy mixture of chocolate and chopped almonds and hazelnuts; other nuts can be used)
  • Nut flours (almond flour is the most common)

Foods that may contain tree nuts include:

  • Macaroons
  • Granola bars
  • Trail mix
  • Cereal
  • Fudge
  • Caponata (a dish made from eggplant that often includes pine nuts)
  • Ice cream
  • Candy bars
  • Baked goods
  • Crackers
  • Cookies
  • Energy bars
  • Flavored coffee
  • Frozen desserts
  • Marinades
  • Barbecue sauces
  • Mortadella (lunchmeat)
  • Nougat
  • Nut meal
  • Natural extracts: almond and wintergreen (filbert/hazelnut allergy)

There are some places where it may be difficult to avoid tree nuts. These include parties or gatherings where bowls of mixed nuts may be served.

As with many common allergens, tree nuts are sometimes found in unlikely foods, so be sure to read labels on all packaged foods before buying or eating them.

Is Coconut a Tree Nut?

Many people consider coconut a fruit. When the FDA mandated that coconut be considered a tree nut for labeling purposes, it caused some confusion.

In fact, coconut allergy is uncommon, and people with a tree nut allergy are not at an increased risk of being allergic to coconuts.

Eating out With Tree Nut Allergies

Tree nuts aren't as common in restaurant cuisines as other allergens. However, the risk of a dangerous reaction makes eating out tricky.

Cuisines that may use nuts include:

  • Greek (some dishes use walnuts)
  • Chinese (cashews are included in many stir-fry dishes)
  • Mediterranean (almonds are common)
  • Italian (pesto is made with pine nuts)

In addition, restaurants may use tree nut oils to make marinades and salad dressings. 

Risk of Anaphylaxis (Severe Allergic Reaction)

Tree nut allergy is among the top four allergens causing the most severe allergic reactions (the other three are peanut, fish, and shellfish).

It's essential that anyone with a tree nut allergy learn the symptoms of anaphylactic shock and carry injectable epinephrine at all times.

If you also have asthma, you have a higher risk for a severe allergic reaction.

Anyone who has a tree nut allergy or takes care of a child with a tree nut allergy should be thoroughly briefed on reading labels, the symptoms of severe food allergies, and treating food allergies.

A Word From Verywell

Managing your tree nut allergy depends on strict avoidance of the tree nuts that cause your allergic symptoms.

As the parent of a young child with a tree nut allergy, you'll need to inform the other adults in your child's life in order to keep your child safe, including caregivers, school teachers and administrators, and the parents of close friends. It is important to teach children how to avoid allergens and manage food allergies.

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5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading
  • Joneja, Janice Vickerstaff. The Health Professional's Guide to Food Allergies and Intolerances. 2013. Academy of Nutrition and DIetetics.
  • Sicherer, Scott. Food Allergies. A Complete Guide for Eating When Your Life Depends on It. 2013. The Johns Hopkins University Press. Baltimore, MD.