For both children and adults, tree nut allergies are one of the most common food allergies. For infants and younger children, in particular, it is the second most common food allergy.

Typically, individuals with tree nut allergies are not just allergic to one type of tree nut, so physicians recommend avoiding all tree nuts and possibly peanuts (even though a peanut is a legume and not a nut).

Under U.S. law, the following common nuts are considered “tree nuts”: almonds, Brazil nuts, cashews, chestnuts, filberts, hazelnuts, macadamia nuts, pecans, pine nuts, pistachios, and walnuts. Less common nuts that also fall under this law include beechnut, butternut, chinquapin, coconut, ginkgo, hickory, lychee nut, pili nut, and shea nut. Disclosure on food labels of all of these tree nuts is required by law.

The most common symptoms of an allergic reaction to tree nuts include:

• Eczema
• Hives
• Itching of mouth, throat, eyes, skin, or other areas
• Asthma, shortness of breath
• Runny nose or nasal congestion
• Nausea
• Vomiting
• Digestive symptoms (abdominal pain, cramps, or diarrhea)
• Difficulty swallowing
• Anaphylaxis
  • Constriction of airways (swollen throat or a lump in the throat making breathing difficult)
  • Abdominal pain and cramping
  • Rapid pulse
  • Shock (a severe drop in blood pressure felt as dizziness, lightheadedness, or loss of consciousness)

Tree nuts tend to cause particularly severe allergic reactions, even if very small amounts are consumed. Many people are not aware of previous exposure or allergies to tree nuts when they have their first reaction. Tree nut allergies tend to be lifelong; only about 9% of children will outgrow tree nut allergies.

There are many unexpected sources of tree nuts, so reading food labels is important to eliminate exposure to tree nuts. Tree nuts are often ingredients in prepared products and ethnic cuisines, such as African, Chinese, Mexican, Thai, and Vietnamese. Natural extracts, such as almond or wintergreen extract, may contain tree nut protein. Tree nuts also can be found in household products, such as lotions and soaps.

Many items may not contain tree nuts but may be produced in a facility where tree nuts are used. As a result, cross-contact with tree nuts may occur. Many snack foods may be produced in a facility where many different types of snack foods or varieties of a product (for example, cereal bars) are produced. Some of the varieties of that product may include tree nuts. A product that is labeled as being produced in a facility with tree nuts should not be consumed by an individual with a tree nut allergy.

Products or Ingredients with Tree Nuts

• All tree nuts (see next page for a full list of tree nuts)
• Artificial nuts and flavoring
• Baked goods
• Barbeque sauces
• Black walnut hull extract (flavoring)
• Breading for chicken
• Candies
• Energy bars
• Fish dishes
• Gianduja (a chocolate-nut mixture)
• Granola bars
• Honey
• Mandelonas (peanuts soaked in almond flavoring)
• Marinades
• Marzipan/almond paste
• Meat-free burgers
• Mortadella
• Natural nut extracts and flavorings (for example, almond, walnut)
• Nougat
• Nut butters (for example, cashew butter)
• Nut distillates/alcoholic extracts
• Nut meal
• Nut meat
• Nut milk (for example, almond milk, cashew milk)
• Nut oils (for example, walnut oil or almond oil)
• Nut paste (for example, almond paste)
• Pancakes, waffles
• Pasta
• Pesto
• Pie crust
• Praline
• Salads and salad dressing
• Walnut hull extract (flavoring)

Child nutrition staff should always read labels carefully, even for foods that do not generally contain tree nuts. The following chart lists common menu items that may be used as safe alternatives to items that contain tree nuts.

*Always check the ingredient label to verify ingredients and check for potential cross-contact.

Some types of food allergies may go away on their own, but there is no cure yet for food allergies. If you have a food allergy, you should not eat that food. Here are some suggestions to help keep you safe:

• Read food labels. Packages will have a special note, usually near the ingredients list. You can also check the ingredients list for anything you should avoid. Your doctor's office or a food allergy organization can give you a list of ingredients to avoid. And don't forget to check a product every time you buy it. Sometimes the food maker may change its ingredients.
• Find out if the factory matters. If you are very sensitive, you may need to avoid a food just because it is made in the same factory as your allergic food. Ask your doctor about that.
• Tell people who might need to know. Teachers, coaches, friends, and restaurant servers can help you stay safe if they know what foods you need to avoid.
• Be prepared. Learn what to do in case you have a reaction.Some people with a food allergy need to have medicine nearby all the time. You may need an EpiPen to protect you in case you have a life-threatening reaction called anaphylaxis (say: an-uh-fuh-LAK-suhss). You might also consider wearing a medical identification bracelet, so other people know how to help you in an emergency.

Food labels can help consumers with food allergies avoid foods or ingredients that they or their families are allergic to.

This is because a federal law, the Federal Food, Drug and Cosmetic Act, requires that the labels of most packaged foods marketed in the U.S. disclose — in simple-to-understand terms — when they are made with a “major food allergen.”

Nine foods, and ingredients containing their proteins, are defined as major food allergens. These foods account for the large majority of severe food allergic reactions:

• milk
• egg
• fish, such as bass, flounder, or cod
• Crustacean shellfish, such as crab, lobster, or shrimp
• tree nuts, such as almonds, pecans, or walnuts
• wheat
• peanuts
• soybeans
• sesame

The law requires that food labels identify the food source of all major food allergens used to make the food. This requirement is met if the common or usual name of an ingredient already identifies that allergen's food source name (for example, buttermilk). Otherwise, the allergen's food source must be declared at least once on the food label in one of two ways.

The name of the food source of a major allergen must appear:

In parentheses following the name of the ingredient.

Examples: "lecithin (soy)," "flour (wheat)," and "whey (milk)"

-OR-

Immediately after or next to the list of ingredients in a "contains" statement.

Example: "Contains Wheat, Milk, and Soy."

The “Contains” statement, if present, must list all allergens that are in the product. “So, if a ‘Contains’ statement has your allergen listed, put the food product back on the shelf,” says Carol D'Lima, food technologist with the Office of Nutrition and Food Labeling at the U.S. Food and Drug Administration.

However, not all allergen-containing products have a “Contains” statement. So, to be sure that an allergen is not present, consumers should always read all ingredient information on the label. “It’s very important to read the entire ingredient list to see if your allergen is present. If you see its name even once, it’s back to the shelf for that food product too.”

There are many different ingredients that contain the same major food allergen, but sometimes the ingredients’ names do not indicate their specific food sources. For example, casein, sodium caseinate, and whey are all milk proteins. Although the same allergen can be present in multiple ingredients, its “food source name” (for example, milk) must appear in the ingredient list just once to comply with labeling requirements.

Sesame was not a major food allergen under the Food Allergen Labeling and Consumer Protection Act of 2004. Sesame became the ninth  major food allergen in 2021 with the signing of the Food Allergy Safety, Treatment, Education and Research (FASTER) Act. As of January 1, 2023, sesame is required to be labeled as an allergen on food packages, including dietary supplements.  

Even though the requirement that sesame be listed on the label as an allergen is in effect as of January 1, 2023, you still may find food products for sale that don’t list sesame as an allergen on the label. 

The law does not require food products that were already on their way to the store or in stock before 2023 to list sesame as an allergen on the label. So for now, consumers may still want to check with the manufacturer.

Allergen labeling requirements for foods that aren’t packaged may vary, like bagels in a grocery bin or bakery goods displayed on trays. If you’re concerned about those products, you may want to ask store personnel for food allergen information. 

"Contains" and "May Contain" Have Different Meanings 

If a “Contains” statement appears on a food label, it must include the food source names of all major food allergens used as ingredients. For example, if “whey,” “egg yolks,” and a “natural flavor” that contained peanut proteins are listed as ingredients, the “Contains” statement must identify the words “milk,” “egg,” and “peanuts.”

Some manufacturers voluntarily include a separate advisory statement, such as “may contain”  or "produced in a facility," on their labels when there is a chance that a food allergen could be present. A manufacturer might use the same equipment to make different products. Even after cleaning this equipment, a small amount of an allergen (such as peanuts) that was used to make one product (such as cookies) may become part of another product (such as crackers). In this case, the cracker label might state “may contain peanuts.”

Be aware that the “may contain” statement is voluntary, says D'Lima. “Not all manufacturers use it.”

When in Doubt, Leave It Out

A food product's ingredients can be changed at any time, so D'Lima says it’s a good idea to check the label every time you buy the product — even if you have eaten it before and didn’t have an allergic reaction.

“If you’re unsure about whether a food product contains any ingredient to which you are sensitive, don’t buy it, or check with the manufacturer or distributor listed on the food product's label first to ask what it contains," says D'Lima.