Tree nut allergies, in some ways, can be the easiest food allergies to have, and in other ways incredibly difficult. Due to the awareness of nut allergies and the high cost of many tree nuts, they are prominently declared in most foods and easy to avoid.
However, with the rise of plant-based diets, nuts are a go-to protein used to make dairy alternatives and add protein to meals.
If you recently found out your baby has a tree nut allergy, the first step is to take a look at everything in your house, become acquainted with the foods that contain tree nuts, understand how to read labels, and familiarize yourself with other names for tree nuts in ingredient lists.
Foods That Sneak in Tree Nuts:
- Walnuts & almonds are commonly added to cookies, pastries, and breads
- Crumbled pistachio, macadamia and hazelnut create a crunchy topping on pastries
- Many store-bought loaves of bread add in seeds & nuts
- Many chocolates have versions with almonds or other nuts. Be wary of cross contamination.
- Coffee, creamers and hot chocolate often have hazelnut
- Almond milk is a popular milk alternative
- Vegan cheeses and ice creams are made with nuts
- Cereals and granola commonly have tree nuts
- Trail mix
- Energy bars use nuts for protein
- Mediteranian cuisines use pistachios, almonds, and other nuts
- Indian food uses cashew to create cream sauces
- Thai / Chinese / Malay / Indonesian cuisine uses mostly peanut but can include tree nuts
- Any food labeled as Vegan
- Veggie burgers or other meat replacements
- Sauces. Especially pesto and mole sauce
- Cooking oils
Allergen Labeling on Packaged Goods
The Food Allergen Labelling and Consumer Protection Act (FALCPA) was passed in the U.S. in 2004. This Act requires the presence of the eight major food allergens — milk, egg, fish, crustacean shellfish, tree nuts, wheat, tree nuts, soybeans — in any packaged food to be declared using a name that is recognizable in the ingredients list.
In addition to the ingredients list there may also be a 'Contains' statement which must either immediately follow the ingredients list or be next to it on the package. If there is no 'Contains' statement on the package then the common English name for the allergen must be included in the ingredients list.
If a 'Contains' statement is used then the food may be listed in the ingredients list using just its chemical name e.g. sodium caseinate, because in this case, the milk from which it is derived will be listed in the "Contains" statement saying “Milk.”
Be careful and always read both the ingredients list and the Contains statement as they are not always consistent.
Cautionary or Advisory Labeling
The FDA does not require manufacturers to declare if nuts are used or held in the same facility as the packaged food you are reading, but more and more companies are doing so to be transparent with their customers.
Examples of cautionary labels include:
- "May contain tree nut"
- "Manufactured in a facility that uses tree nut ingredients"
- "Manufactured in a facility which processes tree nuts"
- "Processed in a facility that uses tree nut"
- "Manufactured on equipment that processes products containing tree nuts"
- "Manufactured on equipment that uses tree nuts"
- "Manufactured in a facility that processes tree nuts, but not on the same equipment"
- "Manufactured on shared equipment...may contain tree nuts"
Each manufacturer can decide what, if any, statement they make about other allergens. You should not assume that one statement means there is less likelihood of cross contamination than another statement.
On the other hand, since no statement is required, you should not assume that one of these statements increases the chances of cross contamination either.
Every parent of a child with a tree nut allergy or person with a tree nut allergy must determine for themselves, based on their past experiences with packaged foods, what they are comfortable with.
How You Can Prevent Accidental Tree Nut Exposure
Here are some tips for navigating various places you or your child will eat.
- Always tell your server about your allergy, even if you don’t think it would normally be made with nuts.
- If your child is allergic to a nut, make sure that the food you are ordering doesn’t substitute nuts. For example, pesto is made with pine nuts, but due to cost, many restaurants make pesto with walnuts instead.
- Never feel uncomfortable asking about the ingredients, including what kinds of oils or sauces the food is prepared with.
- Depending on your child’s sensitivity, it is also okay to ask that utensils be cleaned separately.
- A recent Supreme Court decision determined that food allergies are a protected disability class under the Americans with Disabilities Act. Every restaurant has to accomodate you, even if bring your own food.
Leaving a Child with Friends or Family Members
- If your child is old enough, teach them to use their emergency medications.
- Give each person an emergency plan, and talk through it with them. Describe what food reactions have looked like in the past so they know what to look for.
- Bring food or give caregivers specific lists of brands you are comfortable with. If someone else is shopping for your baby, tell them which brands you trust and be specific — it’s easy to accidentally buy a similar looking package.
- Don’t worry if you don’t feel comfortable leaving your child alone yet. Bring your child with you and your friends will understand.
- Do a trial run with family members where you can see what they feed your child or how they keep their area free of nuts.
- Remember that each school wants to keep your child safe. Ask to set up a meeting to discuss your baby’s tree nut allergy and what she needs.
- Most schools are required to create a 504 plan with parents. The goal of 504 plans is for children to be in the same classrooms with all other children, but with the services, changes, or help they need.
Bring Your Epinephrine Auto Injector Everywhere
It is critical for a baby with a food allergy to always have an EpiPen nearby. Allergic reactions can happen ANYWHERE.
People eat and snack just about everywhere, rarely wash their hands after eating and always wipe their hands on their clothes. Children can be the worst offenders, drooling on toys, play sets, and play areas after they eat.
Lastly, your curious toddler can put just about anything in their mouth. Before becoming a parent, no one thought they’d have to say “Don’t lick the banister!”
Know the Rules for Treating a Reaction
Every family needs to make, review, and agree on an action plan for allergic reactions with their doctor. Food Allergy Research & Education has an action plan any family can use and adapt to their circumstances.
The key to your action plan is:
- At any sign of a reaction, give your child Benadryl. Check out this chart for how much Benadryl to give depending on your baby’s age and weight
- If two body systems start to be involved in the reaction (like hives AND vomiting), use epinephrine and go to the ER
- If any critical body systems are involved in the reaction (trouble breathing, drop in blood pressure), use epinephrine and call 911.
Food allergy reactions can continue to evolve for a few hours after the initial exposure. It is important to stay with your baby for that whole time. If it is late at night and you feel you won’t be able to stay awake, go to the ER.
Whenever epinephrine is used, a child must go to urgent care or the ER. Your child may not need any more medicine after the epinephrine, but symptoms can worsen or improve over several hours after an exposure. Being near medical care will keep your child safe until they are in the clear.
Advocate For Your Child
Food allergies are not an inconvenience, they are about your child’s safety and their ability to participate in the world like everyone else. Thanks to the increased awareness of food allergies, more people are listening.
Don’t be afraid to state what your child needs and ask that your child be allowed to bring safe food. And as your child gets older, teach them to advocate for themselves. It will help them go through the world with less worry.