Managing a Peanut or Tree Nut Allergy

Navigating a nut allergy means doing your homework to keep everyone safe

Like squirrels, a lot of us have nuts stashed throughout our homes. Cashew butter in the pantry. A snack bag of almonds in a desk drawer. A tub of Rocky Road ice cream in the freezer. Maybe even shampoo or lotion with tree nut oil in the bathroom.

These are products you might use regularly without worry. But for someone with a peanut or tree nut allergy, they can spell trouble.

Nut allergies are the most common type of serious food allergy — and most often linked to anaphylaxis, a life-threatening allergic reaction. That’s why awareness and understanding of nut allergies are vital if someone in your family is affected.

“While it’s possible to outgrow them, most kids who develop a peanut or tree nut allergy have them for the rest of their lives,” says David Anmuth, MD, pediatric allergist and immunologist at Geisinger. “And while managing your child’s nut allergy takes some work, with a little preparation and detective work, you can help reduce their risk of exposure.”

What is a nut allergy?

A nut allergy is an abnormal immune response to proteins found in nuts.

“After someone with a nut allergy has an exposure, the immune system mistakenly identifies these proteins as threats,” says Dr. Anmuth. “In defense, the body releases chemicals like histamine, which triggers various allergic reactions ranging from mild to severe.”

Kids with a tree nut allergy may be allergic to one or several tree nuts, including:

Almonds
Brazil nuts
Cashews
Hazelnuts
Pecans
Pistachios
Walnuts

Besides tree nuts, kids can be allergic to peanuts. Peanuts are legumes and not a true nut, so having a peanut allergy doesn’t automatically mean you’re allergic to tree nuts. However, about 25% to 40% of kids allergic to peanuts also react to at least one type of tree nut.

Exposure to nuts can happen in a few ways:

Direct contact with nuts or nut products – Eating (or sometimes touching) products that contain nuts. Even trace amounts can provoke a reaction.
Cross-contamination – When food accidentally comes into contact with nuts, either while cooking or by foods processed in facilities that also handle nuts.

“If you use a knife to spread peanut butter, wipe it off without washing it and then use it for jelly, the jelly will become contaminated with the proteins from the peanut butter,” says Dr. Anmuth.

What are nut allergy symptoms?

Allergic reactions look different for everyone. Symptoms of nut allergies typically appear within minutes after exposure and can range from mild to life-threatening.

Nut allergy symptoms include:

Itchy skin
Hives
Tingling of the mouth and throat
Swelling of the lips or mouth
Coughing
Hoarseness
Stomach pain, nausea or vomiting
Diarrhea

“The most severe allergic response is anaphylaxis, which is a whole-body reaction that comes on fast and is life-threatening,” says Dr. Anmuth. “It requires immediate medical attention.”

Call 911 or head to the nearest emergency room if your child has any of these severe nut allergy symptoms:

Swelling of the tongue and throat
Wheezing and shortness of breath due to constriction of airways
A sudden drop in blood pressure
Rapid heartbeat
Pale skin or blue lips
Dizziness
Fainting or loss of consciousness

Diagnosis and management of a nut allergy

If your child has symptoms of a nut allergy, schedule an appointment with an allergist for testing and evaluation.

To diagnose a nut allergy, an allergist can perform a blood test to look for allergen-specific antibodies or skin test, where the skin is pricked and exposed to small amounts of nut extracts. If your child reacts, the affected area will swell like an insect bite.

If a nut allergy is confirmed, the allergist will prescribe an epinephrine auto-injector, such as an EpiPen^®, in case of anaphylaxis. They might also recommend carrying over-the-counter antihistamines to treat mild symptoms.

“Staying informed is key to handling any allergy,” says Dr. Anmuth. “The only way to prevent an allergic reaction is to eliminate nuts and any risk of exposure from your child’s diet. With some preparation and prevention, your child can feel their best.”

He offers 5 steps to reduce the likelihood of a nut allergy emergency:

Make a plan with your doctor. If your child has a peanut or tree nut allergy, your doctor will draft an emergency care plan. Accidents happen, and a care plan offers instructions on how to treat allergic reactions. It may include information on:

Your child’s dietary restrictions
Symptoms
Situations that might require epinephrine (e.g., EpiPen, Neffy^®)
When to call 911

“Discuss your child’s food allergy emergency plan with anyone who spends time with them, like teachers, coaches and daycare providers,” says Dr. Anmuth. “Keeping communication open can reduce your child’s risk.”

Read labels. Nuts are often found in baked goods, chocolate, bread, cereal and sauce. Read the ingredients carefully to avoid any foods that contain nuts. But products that don’t contain nuts may still pose a risk of contamination.

So even if it’s something you buy regularly, check the label to identify any changes to ingredients. Avoid products with these phrases on the package:

“May contain traces of tree nuts.”
“Processed in a facility that also processes nuts.”

If you see similar phrasing, the product may be risky. To be sure the product is nut-free, choose labels that say “made in a dedicated nut-free facility” or something similar.

Practice kitchen safety. Avoiding accidental nut exposure starts in your kitchen. “If you keep nuts in your home, be mindful of cross-contamination from cutting boards, utensils and cookware,” says Dr. Anmuth.

To keep mealtime as safe as possible:

Create a dedicated nut-free cooking area.
Wipe down surfaces before and after cooking.
Store foods with nut ingredients in separate containers — and, if possible, in a separate fridge or cabinet.

Rely on meal prep. Consider packing your child’s lunches for school, as an added layer of protection. And for birthday parties or get-togethers, think about making snacks yourself. If your child is attending an event, send them with nut-free provisions to keep them full.

“Teach your kids to never share food or eat anything they’re unsure about,” says Dr. Anmuth.

Ask ahead of time. If you plan to eat at a restaurant, choose carefully. Start by browsing menus online. Or, for extra security, contact the restaurant directly. Ask if their menu is safe for someone with a nut allergy. If it isn’t, look for another spot. Many restaurants are becoming more food allergy aware, and some offer food allergy policies and allergy menus.

When in doubt, communicate your child’s nut allergy

Helping your child manage a nut allergy takes work. But by arming yourself with information you’ll help everyone. Have a conversation with your child about nut allergies. Let them know which things are “safe foods” and which are “unsafe foods,” and what to do in case of accidental exposure.

Besides talking to your kids, chat with your friends and neighbors, too. A conversation never hurts to keep everyone on the same page.

“Navigating a nut allergy means being careful about what your child eats and keeping the lines of communication open,” says Dr. Anmuth. “But it also means your child can lead a healthy life without nuts.”