|Kristi Winkels, RD
Question: We know that my son has major food allergies which include nuts. How do you decide which one to ignore?
Knowing which nuts to avoid can be a challenge. First, it is important to distinguish between “nuts”. People often put peanuts and tree nuts in the same category when actually, peanuts and tree nuts are in two separate allergen categories. This is because peanuts are technically legumes, not nuts. It is possible for a person to have a tree nut allergy but still tolerate peanuts and vice versa.
To make things even more complicated, an allergy to one type of tree nut does not necessarily mean an allergy to all types of tree nuts. You can review the list of tree nuts on my website.
Determining which nuts to avoid can be done in a few ways. According to the American Academy of Allergy, Asthma and Immunology (AAAAI), food allergies are most often diagnosed by history. Your child may have eaten something and had symptoms of an allergic reaction shortly after. Taking note of all of the foods that might have been responsible for this reaction is an important part of diagnosis. In children especially, the culprit is often a “new” food, but could also be something that has been eaten with no symptoms in the past.
Once you suspect a food (or foods), the next step is to be tested for an allergy to the food(s). An allergist or immunologist is best qualified to do testing which can include skin prick testing or a blood test. Using your child’s history helps the allergist determine what allergens should be tested. Specific tree nuts can be tested which would help your allergist to determine which tree nuts your child should avoid.
Allergists will often recommend avoiding all tree nuts because of the high risk of cross contamination between the various types of nuts during processing and packaging. It is important to ask your allergist for a recommendation specific to your child. This will likely be based on history and allergy testing done and will be individualized for your child.
Luckily, the Food Allergen Labeling and Consumer Protection Act of 2004 states that foods containing the top 8 allergens must identify those allergens on the label (this includes peanuts and tree nuts). The type of tree nut must be specified on the label making it easier for those avoiding specific tree nuts.
The labeling law, however, does not require labels to include advisory statements such as “May contain traces of tree nuts”. If you’re concerned about cross-contamination, it is best to contact the company to be sure.
- US FDA food allergen labeling
- Eating with Food Allergies: tree nuts allergy
- American Academy of Allergy, Asthma and Immunology: food allergy tips
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