peanut-freePeanut and tree nut allergies are two of the most common food allergies in both children and adults. Unlike tree nuts, peanuts are considered a legume. For this reason, a peanut allergy does not automatically constitute a tree nut allergy. However, most experts do recommend that a person with an allergy to a particular nut avoid all other types of tree nuts. Discuss with your doctor or allergist which nuts are necessary to avoid. Peanut and tree nut allergies typically appear early in life and are generally not outgrown. The number of children with food allergies, specifically to peanuts and tree nuts, is steadily increasing. Exposure can occur through direct contact, cross contact and even inhalation. The severity of a reaction depends on the amount eaten and how sensitive an individual is.


Peanut allergies are the leading cause of anaphylaxis, the most severe allergic reaction. Anaphylaxis requires immediate attention and symptoms include:

  • Constriction of airways
  • Shock and a severe drop in blood pressure
  • Rapid pulse
  • Dizziness or loss of consciousness

Peanut and tree nut allergies can also trigger other reactions. Symptoms occur within minutes to a few hours of consuming the food. They include:

  • Hives and/or itching
  • Tingling or swelling of the lips, tongue, throat
  • Wheezing and difficulty breathing
  • Nausea, vomiting, diarrhea
  • Fainting or dizziness


If you experience any of these symptoms following consumption of peanuts or tree nuts, contact your doctor about allergy testing. Your doctor may recommend one of two tests:

  • Skin test – A skin prick is used to expose small amounts of the protein to your body. A food allergy is confirmed by the presence of a raised bump or hive at the prick location.
  • Blood test – A blood test, also referred to as an IgE test, measures your immune system’s response to the proteins found in various nuts by counting the number of specific antibodies in your blood.

Survival Skills

It is important to note that you may be allergic to either peanuts or tree nuts, or both. If either allergy is confirmed, you may need to eliminate all foods containing either nut from your diet to prevent a reaction since peanuts and tree nuts are commonly manufactured on the same machinery or in the same plant and cross-contamination is a possibility. Again, discuss with your doctor or allergist which types of nuts you should avoid. Tree nuts include:

  • Almonds
  • Brazil nuts
  • Cashews
  • Chestnuts
  • Hazelnuts
  • Macadamia nuts
  • Pecans
  • Pine nuts
  • Pistachios
  • Walnuts

Food Handling: Oral consumption of peanuts and/or tree nuts is not the only way to trigger a reaction. You may also be affected simply by touching them or by exposure to the proteins that becomes airborne during the cooking process. Keep these products out of the home, and talk to friends and family in advance when attending group functions where it might be cooked or served. Even if you don’t eat the offending food, they must take precautions to avoid cross-contamination by using separate cooking utensils (cutting boards, serving spoons, pots and pans, etc.) for peanut and tree nut-containing products and by washing their hands in between handling of these foods. Shopping: Nut proteins can be particularly well-disguised in food products, so one must be a careful shopper. The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that packaged food products list peanuts or the specific tree nut on the label. They must also specify whether the product was produced in a facility that processes other foods containing peanuts and/or tree nuts. Take a closer look at common peanut- tree nut-containing foods:

  • Cereals, crackers, cookies, candy, chocolates and energy bars
  • Flavored coffee
  • Ice cream and frozen desserts
  • Marinades, salad dressings and barbeque sauces
  • Nougat
  • Pesto
  • Pancakes
  • Meat-free burgers or other vegetarian products
  • Nut butters (try alternatives like soy nut butter and sunflower seed butter)
  • Asian and Mexican dishes
  • Grain breads
  • Marzipan

Eating Out: Eating out can provide an additional challenge. Always be sure to ask detailed questions about ingredients and how the food was prepared – your health and safety are at stake! It may be wise to avoid ice cream parlors, Mexican or Asian restaurants altogether if you are very sensitive to peanuts or tree nuts because of the high risk for cross-contamination in the kitchen.

Don’t Go it Alone

A new diagnosis can be scary. Be sure to build a support of family, friends and healthcare professionals to help you manage your peanut and/or tree nut food allergy. Peanuts and tree nuts are a good source of heart-healthy monounsaturated fats as well as protein. Talk to a doctor or dietitian when eliminating these foods from your diet. They may recommend an adjustment in your meal plan or a supplement to replace nutrients lost by eliminating the offending food and food ingredients. Also talk to your doctor about how to prepare for a reaction. You may treat a mild reaction with oral antihistamines to reduce signs and symptoms and relieve discomfort. If you are at risk for severe reactions or anaphylaxis, your doctor may advise you to wear a medical alert bracelet and/or prescribe an injectable epinephren (EpiPen) to carry with you at all times.

Additional Resources

American College of Allergy, Asthma and Immunology
American Academy of Allergy, Asthma and Immunology
Asthma and Allergy Foundation of America
The Food Allergy & Anaphylaxis Network
The Food Allergy Initiative