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Tree Nut Allergy Diet for Children

General guidelines for tree nut allergy

When your child has a food allergy, he or she must follow an allergy-free diet. This means your child can't have the food they are allergic to, or any products containing that food. The items that your child is allergic to are called allergens.

A tree nut allergy is the immune system's abnormal response to the proteins found in tree nuts. Tree nuts include almonds, pecans, walnuts, and cashews. It's important to read food labels to be able to stay away from foods that contain tree nuts.

The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires U.S. packaged food items to state clearly on the label if they contain tree nuts. FALCPA requires that the specific nut be identified on the label, such as almonds. Some people with a tree nut allergy need to stay away from all tree nuts (listed below). Other people may be able to eat some tree nuts, but not others. Talk with your child's healthcare provider about the right decision for your child.

Some food makers voluntarily include labels that say "may contain tree nuts" or "may be made in a facility where tree nuts are processed." Again, some people who are allergic to one tree nut aren't allergic to all tree nuts. Check with your child's healthcare provider to see if your child should stay away from all tree nuts.

The lists below may not contain all products with tree nuts. But they can help guide your decisions. It is important to always read all food labels.

How to read a label for a tree nut-free diet

Stay away from foods that have any of these ingredients:

  • Almonds

  • Artificial nuts

  • Beechnut

  • Brazil nuts

  • Butternut

  • Cashews

  • Chestnuts

  • Chinquapin nut

  • Coconut

  • Filberts

  • Hazelnuts

  • Gianduja (a creamy mix of chocolate and chopped toasted nuts found in premium or imported chocolate)

  • Ginkgo nut

  • Hazelnut spread

  • Hickory nuts

  • Litchi, lichee, or lychee nut

  • Macadamia nuts

  • Mandelonas (peanuts soaked in almond oil)

  • Marzipan or almond paste

  • Nangai nut

  • Natural nut extract

  • Nougat

  • Nut butters (for example, cashew butter or almond butter)

  • Nut oil, nut pieces, or nut meal

  • Nut paste, such as almond paste

  • Pecans

  • Pesto

  • Pili nut

  • Pine nuts (pignolia)

  • Pistachios

  • Praline

  • Shea nut

  • Walnuts

Talk with your child's healthcare provider about the need to stay away from peanuts.

Other information about tree nuts

  • Artificial nuts are peanuts that have been deflavored. They are then reflavored with a nut such as pecan or walnut.

  • Filberts are hazelnuts.

  • Some natural extracts can contain tree nuts. These include pure almond extract and natural wintergreen extract. A child who is allergic to filberts or hazelnuts should not eat foods with these in them.

  • Imitation or artificially flavored extracts are safe to use.

  • Ethnic foods, commercially prepared baked goods, and candy can be cross-contaminated with nuts. This is because nuts are often used in these types of foods.

  • Tree nuts are being added to a growing variety of foods. These include barbecue sauces, cereals, crackers, and ice creams.

Important points

Foods that don't contain tree nuts could be contaminated during manufacturing. Unfortunately, advisory labels such as "processed in a facility that also processed tree nuts" or "made on shared equipment" are not regulated by the FDA. They are voluntary. Companies are not required to include them. Discuss with your doctor if you may eat products with these labels or if you should avoid them.

There are some foods and products that are not covered by the FALCPA law. These include:

  • Foods that are not regulated by the FDA

  • Cosmetics and personal care items

  • Prescription and over the counter medicines and supplements

  • Toys, crafts, pet foods

When you are not at home

  • For your child's general safety:

  • Always carry 2 epinephrine auto-injectors. Make sure you and those close to you and your child know how to use them.

  • If you don't have epinephrine auto-injectors, talk with your healthcare provider to see if you should carry them.

  • Wear a medical alert bracelet or necklace with your allergy information.

When you are eating out:

  • In a restaurant, food may be cross-contaminated with tree nuts. Always ask about ingredients at restaurants. Do this even if these are foods that your child has eaten in the past.

  • Stay away from buffets with tree nuts to avoid cross-contamination of foods with shared utensils.

Medical Reviewers:

  • Daphne Pierce-Smith RN MSN CCRC
  • Raymond Kent Turley BSN MSN RN