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The Peanut / Nut Allergy Handout
Dr. Antony Ham Pong answers some common peanut and tree nut al ergy questions in this handout (updated in 2008)
that he shares with Al ergicLiving.com’s audience. Dr. Ham Pong has a private al ergy and asthma practice in Ot awa
and practises at the chest clinic in the Children’s Hospital of Eastern Ontario. By Dr. Antony Ham Pong
Peanut and tree nut al ergies are the most common life-threatening food al ergies in children. They are often lifelong but between one in 10 and one in 20 children can outgrow a peanut al ergy. Children with peanut al ergy often cannot stand the smel of peanut, may refuse to touch it, and do not want to stay around when peanut but er is being eaten. This type of violent rejection of peanut but er may be the first sign that a child is peanut al ergic even if the child has never eaten it. Sometimes these children get hives or rash where peanut but er touches the face or skin. If a peanut al ergic child touches peanut and then rubs his or her eyes, the eyes may become very swol en and puf y.
Q. What can happen during an al ergic reaction to peanut?
A. An al ergic reaction to a food usual y begins within minutes but may be delayed for 2 to 4 hours and usual y lasts
only several hours, occasional y a day. The more severe the al ergy, the smal er the amount required to cause a reaction.
Typical immediate al ergic reactions to foods include hives or blotching around the mouth, which may spread to the rest of the body, immediate runny nose, sneezing and itchy watery eyes, coughing, choking or gagging, wheezing and trouble breathing, and cramps, vomiting and diarrhea. The al ergic reaction can stop at any stage, or may progress to Q. What is anaphylaxis?
A. Anaphylaxis is a serious al ergic reaction that is rapid in onset and may cause death. It may occur with a food,
drug or insect sting. Even a trace amount of a food can cause a severe al ergic reaction. Not al al ergic reactions become anaphylaxis. Anaphylaxis can begin minutes after taking a food, or may occur 2 to 4 hours later. Anaphylaxis and death may occur even when the initial reaction seems deceptively mild. Death can also occur immediately or be delayed for several hours. How an al ergic reaction begins does not necessarily tel you that anaphylaxis wil or wil A person having an anaphylactic reaction can have any or al of the fol owing:
a) Swel ing of the upper airway causing trouble breathing, croup-like symptoms, and suf ocation.
b) Swel ing of the lips and tongue with trouble swal owing and breathing.
c) Runny nose, nasal congestion, sneezing, itchy, watery eyes.
d) Skin eruptions such as hives or redness. Itching anywhere.
e) Constriction of the lower airways with wheezing, asthma and cough.
f) Nausea, cramps, diarrhea, vomiting. Dizziness, and feeling like dying. Low blood pressure, shock.
Q. How do I treat an al ergic reaction upon eating a peanut product?
A. Anyone with peanut al ergy should use his or her auto-injectable epinephrine (e.g. EpiPen, Twinject)
immediately when they begin to have reactions to eating peanut accidental y, even if the reaction initial y is minor.
This is important to prevent anaphylaxis, the most severe form of an al ergic reaction.
People who delay treatment with epinephrine are more likely to die. Epinephrine therefore should always be immediately close at hand – not in the locker, in the car, in the hotel room, or next door. A person with asthma is more likely to have a fatal food reaction.
An al ergic reaction, especial y anaphylaxis, can recur 4 to 8 hours after initial treatment. It is important to
go to the hospital immediately for further treatment and to be observed for several hours after.
Q. What does epinephrine do?
A. Epinephrine is the only medication available to a patient to treat and prevent anaphylaxis. Antihistamines
(e.g. Benadryl) treat hives and runny nose but not anaphylaxis. Antihistamines should never be used instead Epinephrine reverses the al ergic reaction, strengthens the heart, opens up the airways to improve breathing and reduce hives and swel ing. However, even epinephrine may not work in severe anaphylactic shock.
How can I tel if my peanut al ergy is “mild” or anaphylactic?
A. Most, if not al , peanut al ergies are considered potential y anaphylactic. You cannot predict which reaction is going
to end in an anaphylactic reaction and which is going to be milder. Anaphylaxis is more likely if you have asthma, or previous anaphylaxis to peanut. Al ergy skin tests or blood tests do not help you predict anaphylaxis – a high value tel s you how likely you are to react on eating the food, not your risk af anaphylaxis.
Even a ‘mild’ food al ergy can cause anaphylaxis if enough of the food is eaten. If you have been prescribed epinephrine, it means that you have a significant risk for life-threatening reactions and are “anaphylactic”.
Whether anaphylaxis wil occur depends on: – whether the person is on medication that can worsen the al ergy (such as beta-blockers, used for glaucoma, – and whether the person is having an asthma at ack at the time or has uncontrol ed asthma.
Q. I have had only a mild reaction to peanut in the past, and have never had breathing dif iculties.
A. Peanut al ergy is potential y life-threatening. Even if mild al ergic reactions have occurred in the past,
severe reactions can stil occur with the same amount of food – in other words, the al ergy can worsen without warning. Do not also expect that you wil have the same amount of time or warning before the reaction occurs
as in the past. Therefore, epinephrine should be available at al times.
Q. How likely is a person to die from peanut or nut al ergy?
A. Very unlikely. More people die from drug al ergy or asthma at acks than food al ergy. The risk can be reduced with
proper precautions. Most anaphylactic deaths outside of a hospital are due to foods (especial y peanuts and nuts), thus the emphasis on these –as they are mostly preventable. But it is important to know that while these food al ergies can be deadly, most nut al ergic people do survive an accidental ingestion of these foods. BE CAREFUL, NOT FEARFUL.
Q. Why is peanut al ergy so dangerous?
A. Even very small amounts of peanuts or nuts can cause serious reactions. The al ergen may be found as
a hidden, unlabel ed part of a food sometimes – the result of accidental cross-contamination during manufacturing.
Al ergic reactions are often caused by eating unlabel ed foods, by not checking food labels properly for the presence of peanut, or from foods that contain hidden, unlabel ed peanut. Peanut is used in many of the foods that children like and often eat. The most common types of foods causing allergic reactions due to peanut
are chocolates, cookies, candies, jam contaminated by a knife used in peanut butter, ice cream and
granola bars. Chocolate and mint ice cream are most likely to contain undeclared nuts, since leftover ice cream
can be added to these without changing the flavour.
Q. How can I tel if a peanut al ergy is going away?
A. Repeating al ergy skin tests and/or blood tests every few years can show whether the al ergy seems to be improving.
If so, then a peanut chal enge (with peanut given under medical supervision, NOT AT HOME) may be carried out.
Only if you are able to eat ful servings of peanut regularly over a one-year period can we consider you to have likely outgrown a peanut al ergy. A highly positive al ergy skin test and high peanut blood level indicates a lower chance of outgrowing a peanut al ergy. If the al ergy is stil there as a teenager, or if there are multiple food al ergies, there is also a lower chance of outgrowing peanut al ergy.
Q. What other foods or activities may use peanut?
A. At school, al ergic reactions to peanut can happen when peanut but er is used for school projects e.g. birdseed
bal s, or when other children eat peanut products and share them with the al ergic child, or the al ergic child accidental y comes into contact with peanut on another child’s hands, mouth, toys, desk or any other area where peanut but er – Peanut but er may be used as a “glue” to hold foods together, e.g. egg rol s and rice squares.
– Peanut but er or peanut flour may be added to barbecue sauce or other foods e.g. chili, mooshu sauce, plum sauce, marinades, curry sauce, pasta sauce and satay sauce to flavour or thicken them.
– Some bird seed and animal food e.g. gerbil and hamster food, bird food granules and dog biscuits may contain
peanut and some people have reacted to playing with animals who have been fed peanut-containing food e.g.
chinchil as and gerbils, presumably because traces of peanut are on the hair of the animals.
– Peanut may contaminate foods made with the same cooking utensils, baking dishes or equipment as similar foods without peanut, such as cookies, breakfast cereals, cheese and crackers, chocolates, chocolate candies, raisin covered – Special occasions such as Easter, Hal oween, Christmas and birthday parties are more dangerous for children with
peanut al ergy because there is more likely to be peanut-containing foods eaten, because it is more dif icult to supervise children properly then, and because normal precautionary schedules are changed.
Q. I have eaten foods label ed “may contain traces of nuts” without any problems. Should I stil avoid them if
I am al ergic to peanut/nuts – since it is only a trace? A. Definitely avoid them! Companies are al owed to use “may contain nuts” or “may contain traces of nuts” or similar
words if they cannot guarantee that a food they are producing is free of nuts. This usual y occurs because nuts are being used in the same machines for other foods. But “a trace” does not imply that the amount is too smal to cause an al ergic reaction. A company that makes similar foods with and without nuts, may have dif iculty cleaning the machines When a food with nuts is put through the machine, traces of nuts may remain. The first batches of foods made after- ward that go through the same machine wil likely be contaminated with nuts. Batches of foods done much later are less likely to contain traces of nuts. But you cannot be sure which batch you are eating. Therefore “may contains” should be avoided. This cross-contamination is most likely to occur with cookies, candies, cereal, chocolate, ice cream, dried soups, and nut but ers. Note that, when the word “nuts” is used, this could mean peanut and/or tree nuts.
Q. What about foods “manufactured in a facility that processes peanuts”. Are these safer?
A. These are not safer and definitely need to be avoided! A recent U.S. study measured peanut contamination in
food label ed “may contain peanuts”; “manufactured in the same facility with peanuts”, and “manufactured on shared equipment with peanut”. They found that one in 20 had detectable peanut protein, and 70 per cent had enough to
cause an al ergic reaction in very sensitive persons. But only one of 358 samples had a fairly large amount – one-third
of a peanut. In fact foods that stated “shared facilities or equipment” tended to be more likely to have peanut that those Q. Do I have to avoid other nuts if I am peanut al ergic?
A. You should ask your al ergist for specific advice. Peanut al ergic patients can have a tree nut al ergy as wel .
However, some peanut al ergic patients are al ergic only to peanut and can safely eat tree nuts. Peanut al ergic patients who can eat tree nuts should be aware that many nuts are processed in the same facilities and cross-contamination can occur, so they should be careful to eat tree nuts that are not contaminated e.g. nuts taken fresh from the shel . However, young children often avoid tree nuts if they are al ergic to peanut because they cannot distinguish between dif erent nuts, and also they are stil at a higher risk of developing a tree nut al ergy. ‘Nu-Nuts’ and ‘Mandelona nuts’ are peanuts that are defat ed and reflavoured to resemble tree nuts and these need to be avoided.
Q. Are peanut oil or tree nut oils safe?
A. Pure refined peanut oil, if properly processed with high heat and chemical extraction, should contain no
peanut protein and therefore should not cause al ergic reactions in peanut al ergic people. Yet, peanut al ergic people
should avoid peanut oil because of the slight risk that the processing of peanut oil was not done properly, and that there may be traces of peanut protein. Nevertheless, if a peanut al ergic person accidental y eats a food with refined peanut oil, the chances of having an al ergic reaction are low because even there is peanut protein in there, it wil likely be in However – peanut and tree nut oils are also available unrefined. They may also be cal ed cold-pressed, un-
processed, expel ed or extruded oils. These unrefined oils may have nut proteins and may cause al ergic reactions, and should be avoided. These unrefined oils are usual y found in specialty food shops and used for specialty ethnic cooking and some specialty salads. They may also be more common in other countries. Peanut oil is also known as Arachis oil.
Note that common oils used for cooking e.g. canola, corn, soy, coconut, olive, saf lower oils, and palm oils do not need to be avoided by nut al ergic persons.
Q. What about seeds, tropical oils, exotic foods?
A. Foods such as water chestnut, coconut, nutmeg, mango, kiwi, palm kernel oil do not need to be avoided by peanut
al ergic people unless they are also al ergic to these foods. But al ergies to these foods are uncommon. Palm oil and tropical oils do not need to be avoided. Seeds – e.g. sesame, sunflower, poppy, mustard, saf lower and canola – do not need to be avoided unless you are al ergic to any of these as wel .
Q. Since peanut is a legume, should I avoid other legumes such as peas, beans or soya?
A. No, not unless you are actual y having al ergic reactions when you eat them. If you have been able to tolerate
peas, beans and other legumes in past, they may be continued (even if your al ergy skin test is positive), unless you begin to react when you eat them. Legumes include peanut, peas, beans, soya, chick peas (garbanzo beans), lentils, split peas, lupin(e) seeds, dahl, tamarind, licorice, carob, soy sprouts, bean sprouts, cassia, alfalfa, fenugreek, Most peanut al ergic people can eat other legumes even if they have a positive skin test to these other legumes.
However, a positive skin test to one of these legumes means that the peanut al ergic person does have some chance of developing an al ergy to the legume later (5 to 15 per cent chance). If an al ergy does develop, it is usual y mild (usual y causing itchy mouth or throat), but occasional y can be severe. The legumes most likely to cause al ergic reactions in peanut al ergic people are dried mature legumes e.g. dried peas and dried beans including soybean, whereas green peas and green beans are often tolerated.
Q. Should vegetable oil be avoided?
A. Not in Canada. Peanut oil must be declared in Canada, so vegetable oil means it is not peanut oil in Canada.
Q. Does peanut have to be declared on a label?
A. General y, yes. Unfortunately there are exemptions. “Flavour, natural flavour, spice, seasoning, curry” are terms
used on labels to describe ingredients that may occasional y contain peanut, but do not have to be declared. This is more likely to occur in imported foods, especial y from countries that use peanut as a flavouring agent. Peanut oil Q. What about hydrolyzed vegetable protein?
A. Hydrolyzed vegetable protein or hydrolyzed plant protein is usual y made from soya, wheat or corn, and is added
to foods to improve flavour and texture. It is rare to have hydrolyzed vegetable protein made from peanut. If in doubt, Q. Can I react to the smel of peanut/nuts?
A. You can be assured that, under normal circumstances, anaphylaxis to airborne food particles is very rare. An
al ergic reaction to food wil not occur because someone is eating it in a classroom or vicinity of the al ergic person. The main reason for advising that the al ergenic food not be brought into a classroom is the potential for an al ergic child to accidental y ingest some by sharing food. Secondary reasons (less likely to cause anaphylaxis because of the smal er quantities involved) are cross-contamination of desks, toys etc.
The smel of peanut/nuts or peanut but er does not come from the peanut protein, and therefore al ergic reactions should not occur just because you smel peanut or because there is an open jar of peanut but er in the area. Al ergic reactions to peanut occur mostly when the peanut enters the body, either by licking it, tasting it or eating it – for instance, bringing it to your lips, mouth directly, or indirectly by transferring it from your hands or other people’s lips to your mouth or eyes. Therefore, it is important to realize that severe al ergic reactions or anaphylaxis to peanut general y occur with eating or tasting peanut, and not by touching or smel ing it.
In fact, the smel of peanut should cause no al ergic reactions at al , but may make a peanut al ergic person feel very uncomfortable because he or she is smel ing something that is distasteful and potential y dangerous if eaten. It is likely a defense mechanism to warn the peanut al ergic person to move away from the area, in case they do get into contact The only exception to the above is if peanut protein itself is in the air that you breathe. If a peanut al ergic person
breathes enough of the peanut protein in the air, the person can have a serious al ergic reaction, asthma at ack or ana- phylaxis. Situations in which this can occur are unusual but can happen. For instance, if a large number of people are opening packages of peanut at the same time – e.g. when peanut packages served on an airplane – and the peanut protein dust gets into the air in an enclosed space. Other examples would be boiling or frying a food with peanut, as minute peanut particles can then get into the air [through steam or oil particles carrying peanut protein]. Another example could be a floor with large amounts of peanut shel s and containing peanut dust where people walking on the shel s can stir up peanut dust in the air. (An example would be sports bars.) However, remember that these reactions might occur only in an enclosed area and with large amounts of peanut dust stirred up in the air, and should not occur with a few peanut shel s scat ered on the ground, or with one or two people eating peanut next to you. Al ergy to inhaled food proteins is rare and may occur in unusual cases. However, it has been reported in some individuals to peanut, wheat, Q. Can I react to touching peanut?
A. Sometimes, but contact reactions are often very mild if peanut is touched to intact skin, or there may be
no reaction at al . This explains why peanut al ergic children can handle al sorts of items potential y contaminated with peanut transferred by another child and have no reactions. Examples are doorknobs, books, toys, computers, water fountains, tabletops and desktops. A food does not have to be eaten to cause an al ergic reaction, but eating it does cause greater amounts to get into the body and usual y causes the most severe reactions. Hives can occur on skin contact with an al ergenic food. If the food goes into the wet surfaces through a cut in the skin, or at the lips (e.g. being kissed by someone who has eaten peanut but er), or in the eye, severe reactions can occur.
Al ergic reactions to peanut occur mostly when the peanut enters the body, either by licking it, tasting it or eating it – i.e.
bringing it to your lips, mouth directly, or indirectly by transferring it from your hands or other people’s lips to your mouth, or eyes. If peanut touches a peanut al ergic person’s skin, either no reaction wil happen, or only a minor reaction with minor skin rash (unless there is a cut in the skin or the skin is damaged. An example would be raw skin from uncon- trol ed eczema, al owing peanut proteins to enter the bloodstream and perhaps cause a more severe reaction).
Therefore it is important to realize that severe reactions or anaphylaxis to peanut general y occur with eating
or tasting a visible amount of peanut (e.g. half a peanut), and not by touching or smel ing it.
Q. Can I react if my date eats peanut and kisses me?
A. Yes. However, as noted above about reactions to the touch of peanut, a peck or kiss on the cheek of a peanut
al ergic person may cause no reaction or a minor hive or skin reaction at the area of the kiss. On the other hand,
kissing on the lips and more intimate kissing with exchange of saliva can provoke more severe reactions, especial y if the kisser has just eaten peanut or nut products and there are significant amounts on the lips or mouth or saliva. This is a common cause of swol en lips in nut al ergic persons at midnight on New Year’s Eve – when sometimes many kisses are shared and so are nut containing snacks! Peanut protein can stay in the saliva after it is eaten, for close to one hour, and occasional y up to four hours. Ask your date not to eat peanut or nuts beforehand, and also as a precaution, brush their teeth and wash hands and face before you meet (I think your date should be doing this anyway).
Q. What about airline travel?
A. General y, traveling is safe as long as proper precautions are taken. Some parents have to become comfort-
able with the idea that the airplane environment is no longer theirs to control before they can travel. Essential points are to make sure auto-injectable epinephrine is immediately at hand, not locked away, and certainly not left in checked lug- gage (unless it is a spare). Carry at least two epinephrine doses, especial y for long flights. It is preferable to carry your own safe food to eat on the plane. Tel the airline about the food al ergy when booking, ask if peanuts are served, and request that they not be served on that flight (it is up to the airline to decide whether to honour your request). Otherwise, Special requests take time and possibly doctor’s let ers of support, so make sure you prepare wel in advance. And don’t worry excessively about peanut contaminating the seats et.c – the major risk is ingesting peanut or nuts. You should check your aircraft seat and seat pockets as you board in case a peanut or nut has been missed by the cleaners and your child finds it. A few persons eating nuts or peanut close to you is not a risk. However, if there is a large amount of peanut dust in the air, this could cause an al ergic or asthmatic reaction in a peanut al ergic person. For instance, if a large number of people begin opening packages of peanut at the same time on the airplane – the peanut protein dust gets into the air in an enclosed space.
The first flight of the day is when the airplane is likely to be the cleanest. Sometimes nuts are served only in the business class section, so a seat at the rear of the plane wil give less chance of accidental exposure. Peanut and nuts are more likely to be served on international flights than domestic flights.
Q. Should I remove peanut from the house if I have a peanut al ergic child?
A. Many parents do so with a young peanut al ergic child to reduce the risk of accidental contact. A few feel they
can safely monitor peanut use in the home and minimize the risk by appropriate storage and clean-up routines. It is a personal decision. When peanut al ergy has been diagnosed, remove foods potential y contaminated with peanut from the home such as ice cream, opened jam, etc.
Q. Can my next child develop a peanut al ergy if one child already has peanut al ergy?
A. Al ergies run in families so your next child has a higher risk of being al ergic, asthmatic or food al ergic, but we
cannot predict what pat ern of al ergies wil develop. The risk of the next child having peanut al ergy is as high as 1 in 7.
You should consider having that child seen by an al ergist between ages 1 to 3 years to identify whether he or she is potential y peanut al ergic, especial y if there is eczema. There is no real way to prevent a child from developing food al ergy. This is controversial and al ergists have dif erent opinions on the subject.
Q. What else should I expect?
A. The Al ergic March. An al ergic child ‘marches’ on to develop more al ergies. Al ergic children who start with
eczema, then food al ergy, often get asthma usual y before age 5 years( 75 per cent risk if you have the first two), fol owed by environmental al ergies such as hay fever.
What Contains Peanut
[those marked with * have caused deaths]
peanut*/peanut butter*/peanut meal
peanut popcorn/peanut shel s/peanut flour peanut sauce/satay sauce*
peanut scented fishing lure (Mann’s Vworm) Peanut but er-flavoured lip gloss (Bonne Bel ) What May Contain Peanut
[those marked with * have caused deaths]
Chocolate*/candies/cookies/donuts*
European chocolates*
Desserts*/sweets*/almond paste*
Chili*/egg rol s*/salsa/barbecue sauce
Milk in the U.S. may sometimes have peanut oil or fish oil (to carry added vitamins). Risk is probably low.
Non-Food Products that May Contain Peanut Products
Medications: These contain peanut oil e.g. Cerumol eardrops, Accutane caps, Prometrium caps, Rocaltrol,
Cosmetics: Peanut but er-flavoured lip gloss; Pears soap (peanut oil)
Miscel aneous: Smal animal food (eg. hamster, gerbil), animal food pel ets eg. at pet ing farm; birdseed mix
or granules (eg. For parakeets, lovebirds, wild birds); dog biscuits.
Examples of How Accidents with Foods Can Happen
1. Eating unlabel ed foods *. If in doubt, don’t.
2. Accidental contamination of other foods e.g. jam or but er, or of eating utensils, food trays, tables and toys.
A common problem is jam contaminated with peanut butter by using the same knife.* Remember that even if a
peanut al ergic child is not of ered peanut but er, eating jam at a home where there is peanut but er may not be safe.
Packing peanut butter sandwiches with other foods *.
3. Unpackaged foods e.g. a cookie jar may contain traces of nuts from previous nut-containing cookies. Another
cookie taken from that jar may contain traces of nuts on it. Bulk foods and buf et meals may also be dangerous because of cross-contamination. Be cautious of free cookie samples at stores.
4. Contamination during preparation. For instance, perhaps a cut ing board is used to prepare 2 foods – e,g,
chicken and fish – and the chicken is served to a fish al ergic person; or perhaps the same board or knife is used to slice or grind nuts. Using the same oil to fry dif erent foods, or the same bat er for dif erent foods, or the same frying utensils for dif erent foods without washing in-between can al cause cross-contamination. Grinding specialty nut- flavoured cof ees in a cof ee grinder. Baking muf ins with and without nuts if leftover bat er is used for other muf ins or if baking pans are not properly cleaned.
5. Contamination during serving e.g. sauces mixed by spil age; the same scoop is used to take scoops of dif erent
ice creams some of which may contain nuts; a knife used to cut a nut-containing dessert and then used to cut another 6. Relying on someone who does not know but who tel s you the food is safe, for instance, another child, or someone who did not prepare the food such as a waiter, salesclerk or airline at endant. Being served an incorrect dish from what was ordered.*
7. Trying a food to see if you are “stil al ergic,” especial y with an anaphylactic al ergy.
8. Tasting a food careful y to see “if it is safe or not” is dangerous. *
9. A change in the way a usual food is made. For instance, a change in the ingredient list without any obvious change on looking at the container. A new chef at a restaurant may change the recipe and add a “secret ingredient” *.
10. Candy machines may have dif erent foods at dif erent times and candies may be contaminated with traces of nuts
if there were previously nuts in the dispensing machine.
11. Be aware of unusual sources of al ergenic foods “See list of “What may contain peanut”.
12. Non-food sources of peanut e.g. homemade playdough, scented crayons, cosmetics or fishing lures with peanut, peanut shel stuf ing in bean bags, draft stoppers, and stuf ed toys, peanut in animal food – hamster, gerbil and bird * These have resulted in deaths.
Suggested Reading
Anaphylaxis: A Handbook for School Boards, published by the Canadian School Boards Association and Health Canada. Contact Canadian School Board Association, 340 Laurier Ave W, P.O. Box 2095, Ot awa, ONT K1P 5W3 Anaphylaxis in Schools and Other Childcare Set ings – Canadian Society of Al ergy and Clinical Immunology, and al ergy support groups: www.csaci.medical.org The Peanut Al ergy Answer Book – Dr. Michael Young What Can Peanut Also Be Cal ed?
What is Not a Peanut or a Tree Nut?
Legumes eg peas, beans Wood or dust from nut trees e.g.
Litchi (Lychee) nut fruit2 1. Coconut is now cal ed a tree nut but an al ergy to it is extremely rare –check with your al ergist 2/3. Fake walnuts & almonds (Nu-Nuts), fake almonds (Mandelonas) 2. Do not eat the nut if you are tree nut al ergic but the fruit is OK What are Tree Nuts?
Tree nuts are large seeds of a tree which are usual y covered by a hard shel . Each group below represents a dif erent family Some people may react to only one family and can eat nuts of a dif erent family. Others are al ergic to many families of nuts.
1. Fruits belonging to the same family as a nut do not need to be avoided e.g. peaches, plums, nectarines, cherries are in the same family as almond,and mango is in the same family as pistachio & cashew. These fruits are safe even if you are al ergic to nuts, but do not eat the seed or nut of the fruit.
2. African tree nuts used in some cosmetics and some candies.
3. Coconut is now cal ed a tree nut, but an al ergy to it is extremely rare and coconut general y does not have to be avoided. Ask your al ergist.
4. Not strictly a tree nut but often referred to and treated as a tree nut.
What Products Can Contain Tree Nuts
[The usual nut/nuts associated with the name is in brackets, but other nuts may be used as wel ] Worcestershire sauce, Crosse & Blackwel NON-FOOD PRODUCTS WHICH MAY CONTAIN TREE NUTS
Medication: Aim herbal fiber blend (walnut)
Cosmetics: Dragon Mist Body Piercing Lotion (walnut); suntan lotions; cosmetics and hair-care products;
body lotions, creams, soaps & moisturizers (e.g. almond, shea, kuki nut ); Morikue (Brazil nut extract) in Aveda Shampure Shampoo and Conditioner; Cetaphil cream (almond oil).
Miscel aneous: Black walnut shel used in jewelry, industrial abrasive and blast cleaner, dental cleansers, soaps
and cosmetics; bird seed mix especial y for parrots and parakeets, smal animal food mix e.g. hamster & gerbil.
Dr. Ham Pong notes that the handout is intended for general information only. For specific medical advice, consult your al ergist.

Source: http://www.nask.ca/files/drham-2008.pdf