Tree nut allergy factsheet

Introduction

Tree nut allergies are one of the most common and severe allergies in children.

Common tree nuts include:

almonds
brazil nuts
cashews
chestnuts
hazelnuts
hickory nuts
macadamia nuts
pecans
pistachios
walnuts.

Children allergic to one tree nut are often allergic to other tree nuts. Cashew is the most common tree nut allergy.

Tree nuts are different from peanuts. Peanuts come from a plant family called legumes that grow in the ground.

Around 1 in 3 children with tree nut allergies are allergic to peanuts.

Tree nut allergies can develop at any time from 6 months of age throughout your child’s life. They can become more severe as your child grows, and only a few children with mild reactions will outgrow the allergy.

Some children are more at risk of having a tree nut allergy. Risk factors include:

a family history of allergies and asthma
having eczema
having other allergies.

Like any other allergy, it is important to talk to your child’s doctor before reintroducing foods that have previously caused an allergic reaction.

Signs and symptoms

Allergic reactions can be fast and happen within minutes of exposure to tree nuts.

Reactions can include:

hives or welts
redness of the skin
vomiting and stomach ache
tingling and swelling of the mouth, lips, face, and eyes.

Some children can have a more severe allergic reaction called anaphylaxis.

Signs of anaphylaxis include:

wheezing, difficult, or noisy breathing
swelling of the tongue
swelling or tightness in the throat
a persistent cough
difficulty talking or a hoarse voice
dizziness
becoming pale and floppy in young children
collapsing.

If your child has signs of anaphylaxis, you should:

follow your child’s ASCIA action plan for anaphylaxis if you have one
use an EpiPen® or Anapen®, if there is one available
call Triple Zero (000) for an ambulance.

See your local doctor as soon as possible if your child is showing signs of an allergic reaction for the first time.

Symptoms of mild allergic reactions should fade over time. See your local doctor as soon as possible if symptoms do not get better or you are concerned.

Diagnosis

If you think your child has had an allergic reaction that is not anaphylaxis, write down the following and see your local doctor as soon as possible:

time your child was exposed to the tree nut
time of reaction
type of reaction
amount of tree nut eaten.

A specialist doctor can diagnose a tree nut allergy based on your child's:

medical history
signs and symptoms
results from allergy tests.

Some children will grow out of their tree nut allergy.

A food challenge can be done to figure out whether your child has grown out of their allergy and whether tree nuts can be reintroduced to their diet safely. Food challenges are done under the supervision of a doctor in the hospital.

Treatment

Your child's doctor will find the best possible treatment for their allergy based on their individual health needs.

In most cases, your child must carefully avoid tree nuts in their diet.

Children at risk of anaphylaxis need:

an ASCIA action plan
an adrenaline injector, also known as an EpiPen® or Anapen®.

Your child will also need to learn how to identify foods that contain tree nuts as they get older and become more independent with their diet.

Management

Common sources of tree nuts

Tree nuts are a common ingredient in food, so they can be difficult to avoid.

Some foods will visibly contain tree nuts, for example, when nuts are used as a garnish.

They can also be in other foods like:

baked goods - for example, cake, muffins, and biscuits
desserts - for example, carrot cake, chocolate, ice cream, and nougat
breakfast cereals, muesli, and granola
dips, sauces, spreads, and marinades - for example, tikka masala, romesco sauce and nut butter.

Tree nuts are also common in noodles, curry, stir-fries, and rice dishes.

Tree nuts, in particular cashews, are also commonly used in plant-based or dairy-free cheese and cream, so it is important to always check the package and ingredients list of all foods that your child is exposed to.

Tree nuts, food labels and eating out

It is important to always check the package and ingredient list of all foods your child eats.

In Australia, allergens are shown in bold each time they appear in an ingredient list. Packaged foods may have a warning on the label that "may contain traces of tree nuts".

This means the food is made in a facility that also makes foods that contain tree nuts.

Always tell the staff that your child has a tree nuts allergy when eating out. This will help you find safe foods and avoid contamination.

If you cannot confirm that food does not contain tree nuts, it is safest for your child to avoid it.

Talk to your child’s doctor about what foods containing tree nuts are safe if you are unsure.

Education

The most important thing you can do is support your child in avoiding tree nuts in their diet. You can also educate your child, family, and friends about allergies, reactions, and what to do in an emergency.

Parents of younger children will need to read ingredient lists and learn to find tree nuts in foods and drinks.

Older children can be supported in learning to read ingredient lists and find tree nuts in foods.

This can help keep children safe and encourage them to be more independent and confident about their diet and health as they grow.