Wednesday, April 17, 2013

All About Tree Nut Allergies: For One Thing, They're Not Peanuts

Tree nut allergies are not peanut allergies. But you can be severely allergic to
one or both. What are tree nuts? Read on...
When telling someone that you or your child has a nut allergy, you have probably discovered that many people take this to mean a peanut allergy, only. However, in recent years, studies have shown that an increasing number of people with peanut allergies have a tree nut allergy, too. (This is the case with my daughter and I know many of you share this.)

According to a study published in the Journal of Allergy and Clinical Immunology, the prevalence of childhood tree nut allergy increased significantly in the last 10 years. (1.1% in 2008, 0.5% in 2002, and 0.2% in 1997). Here is a link to that article.

Tree nut allergies are sometimes difficult to explain and these allergens are often difficult to avoid. With their "super food" status, it seems that tree nuts like almonds, cashews and walnuts are now everywhere, being added to just about everything. Approach any new foods with caution and keep up on the labels/practices of your favorites in case of changes.

Of course, many people have a tree nut allergy -- only -- and no peanut allergy. So in this case, you really might have to be extra clear when explaining what you need to avoid.

I can think of several occasions when I described my child's nut allergy to someone and told them that she was allergic to both peanuts and tree nuts. Unfortunately, the message doesn't always get through. One time, a teacher at a park district class my daughter was enrolled in with a friend assured me that "no nuts are used--we know about allergies."  However, almond oil was one of the main ingredients in a project. (They were making glitter lotion.) Almond is a tree nut and one of my daughter's most sensitive tree nut allergies. She wisely avoided the product and everything was OK. But had she been younger/less informed, who knows? Obviously, when I found this out it was scary and disappointing. I realized that I needed to be more clear.

Part of the problem with communicating about tree nut allergies is that peanut allergies get so much press and buzz. If you don't deal with this issue daily, you won't always understand the nuances and that's understandable. So what are tree nut allergies? Here are some facts to help separate the peanuts from the tree nuts.

What the heck is a tree nut?

That's a good question and one I asked my allergist when my daughter was diagnosed with peanut and tree nut allergies. Tree nut allergies are one of the most common food allergies and unfortunately, they can also be one of the most lethal. Tree nut allergies tend to be a lifelong allergy.  Basically, tree nuts grow on trees so they include (but are not limited to) pecans, almonds, walnuts, hazelnuts, Brazil nuts, pistachios, pine nuts and cashews.

However, it's not that simple. Everything that grows on a tree is not a tree nut and every thing called a "nut" is not necessarily something to avoid. Seeds are not tree nuts. Sesame seeds and sunflower seeds are not tree nuts. Coconuts are not tree nuts--they are a fruit. Shea nuts (found in hair and skin products and sometimes as "butter" or oil in foods) are not considered allergenic tree nuts by most allergists. Nutmeg, a popular spice, is actually not a tree nut but the seed of a fruit. See this article about shea butter in an article from Allergic Living by clicking the link. You can read more about tree nut allergies at the FARE website.

Big word of caution here! You can be allergic to just about any substance so before serving any new foods to your child (or yourself) or using a skin/hair product, ask your allergist.

When telling someone about a tree nut allergy, I find it helps to list some as an example. "My daughter is allergic to tree nuts and peanuts. Tree nuts are things like cashews, almonds, pecans and walnuts and many others." It emphasizes that we are not talking about peanuts, but a separate food item.

When speaking to your kids or family members about tree nut allergies, it's really helpful to give a visual of what the types of tree nuts look like. If you don't keep them in the house, your kids might not know! To help educate them, check out this web site. It gives a visual photo for many types of tree nuts.

Peanut-free foods don't always mean tree nut-free

In recent years, many companies have chosen to place labels on their foods that say "peanut-free." (This is not required by law). But that does not necessarily mean "tree nut free." Keep in mind that the FDA calls coconuts "tree nuts" for reasons known only to them. So companies may or may not have tree nuts on the premises--however, if they have coconut, it can't say "tree nut free" on the label.

Peanut-free baked goods may also NOT be tree nut-free. Check into this before buying anything labeled "peanut-free" only if you need to avoid tree nuts, too. The best way to do this is by contacting the company. Never assume peanut-free means tree nut-free too. It doesn't. I talk more about this issue and how to navigate in my e-book since the labeling on nut-free vs. peanut-free is still pretty inconsistent.

What if I only deal with a peanut allergy? Do I need to avoid tree nuts, too?

Only your allergist can answer that question, but if they tell you to avoid with no evidence of a tree nut allergy, there are a few common reasons. One: cross-reactivity. Some studies have shown a significant percentage of cross-reactivity between peanuts and tree nuts in allergic people. Here is a link that explains this. Also, the processing and manufacturing of peanuts and tree nuts means that they may come into contact with one another, resulting in cross-contact risk. This is why you must carefully evaluate packaged/processed peanuts or tree nuts if you have allergies to only one of these foods.

With any food you're unsure of, ask your allergist.

What about you? Do you deal with tree nut allergies or just peanut? Or both? Have you ever had trouble explaining the two?

For more about managing daily life with peanut allergies and/or tree nut allergies, check out my e-book: The New Nut-Free Mom: A Crash Course in Caring for Your Nut-Allergic Child

Sources for this article:

American Academy of Allergy, Asthma and Immunology
Journal of Allergy and Clinical Immunology
FARE -- Food Allergy Research and Education
Allergic Living Magazine

Please note: This blog is not intended to be used as medical advice. Ask your doctor about safe or recommended foods or substances. Thank you!


Unknown said...

I just came across your blog today and I am so sad I haven't found it sooner. LOVE IT!!! I have three children but only my middle child has a severe life threatening allergy to all nuts. Your blog hits on SO MANY things I have dealt with and tried to overcome (the anxiety being one of them). Quick question.... Is Sunflower Butter completely safe for children with all nut allergies? I am scared to try it without some kind of information on it first. I'm not even sure my son would try it since he is so scared of anything that could possibly give him a reaction (he's had at least two very severe reactions so he avoids anything he thinks may cause a reaction).

Jenny said...

Hi Lindsey,

Thanks for your very kind comments! I understand about SunButter. Some children simply don't like the texture of peanut butter substitutes, especially if they remember their reactions. I don't know if your child has sunflower seed allergies, but if not, SunButter brand (that's the only brand I use) is peanut-free, tree nut-free and gluten-free. It is made in a dedicated facility. I would suggest it as a PB substitute for the family if your son doesn't want to use it. At least your family can enjoy it and it is safe to be around your son. Some kids are repelled by anything that resembles the look and texture of peanut butter and that may be the body's natural defense, so don't worry if he doesn't want it. If you deal with only PN/TN allergies it will be safe for him to eat if he wants to try it, but of course, be sure to check any new foods with your allergist. Better to be safe! Thanks for writing! Very best wishes, --Jenny

Anonymous said...

Yes, I agree. If you tell someone your child has a nut allergy, they think that only means peanuts. Then if you explain the different types of nuts, I have had people say oh, you mean all "peanuts".


The Atomic Mom said...

We started out being only peanut. Over the next three years DS developed pecan and walnut allergies, but the doctor told us to avoid all tree nuts. I find that most people, at least in my circle, understand the difference, but I always explain. More and more of our friends have some sort of food allergy as well, so my friends are all very careful, and I appreciate that.

Anonymous said...

Thanks for breaking down the beginning thoughts of what I need to tell people as we just came home today with this realization of our oldest son having a TN allergy. His reaction was severe and I am so thankful for the people who take time to share their thoughts and can get it out in words easy for everyone to understand.

Jenny said...

Thanks, everybody, for your feedback on this post! It seems that lots of us have had to explain the difference between a peanut and tree nut.

Unknown said...

Amazing article! I have a peanut allergy but I found out this year that I am NOT allergic to almonds which is a tree nut. .so I thought maybe I dnt have a tree nut allergy just a peanut one. . But I also know that I am allergic to pistachios which IS a tree I am really confused to why I'm allergic to one tree nut but not another?