Leaflet Details
| Title | It’s All About Nuts |
| Department | Dietetics |
| Author(s) | Dietitians |
| Review Date | August 2025 |
| Next Review | August 2027 |
| Download | A5 Booklet PDF |
| Accessibility Options | Click on the Recite Me button to show our accessibility resources |
Patient Information
INTRODUCTION
Peanut allergy and tree nut allergy - the facts
Peanut allergy and tree nut allergy can sometimes result in severe allergic reactions and understandably this can cause intense anxiety among those affected and their families.
This factsheet aims to answer some of the questions which you and your family might have about living with peanut allergy or tree nut allergy. Our aim is to help you to minimise risks and learn how to treat an allergic reaction should it occur.
The peanut is a legume, related to foods such as peas, beans and lentils. Tree nuts are in a different category and include almonds, hazelnuts, walnuts, cashew nuts, pecans, Brazil nuts, pistachios and macadamia nuts.
A key message for people with peanut or tree nut allergy is take your allergy seriously.
WHAT ARE THE SYMPTOMS THAT COULD OCCUR?
The symptoms of a food allergy can come on rapidly. These may include nettle rash (otherwise known as hives or urticaria) anywhere on the body, or a tingling or itchy feeling in the mouth.
More serious symptoms may include:
- Swelling in the face, throat and/or mouth
- Difficulty breathing
- Severe asthma
- Abdominal pain, nausea and vomiting
The term for this more serious form of allergy is anaphylaxis. In extreme cases there could be a dramatic fall in blood pressure (anaphylactic shock). The person may become weak and floppy and may have a sense of something terrible happening. This may lead to collapse and unconsciousness. On rare occasions, death can occur.
HOW IS AN ALLERGIC REACTION TREATED?
If peanut or tree nut allergy is strongly suspected, and especially when allergy tests have confirmed it, you are likely to be prescribed adrenaline (also known as epinephrine). The adrenaline injectors prescribed in the UK at present are Emerade®, EpiPen® and Jext®.
These injectors are easy to use and designed for self-administration. If you are prescribed an injector, it should be available at all times – with no exceptions. After an injection has been given, someone must dial 999 immediately as symptoms may return after a short period and more than one injection may be required. The emergency service operator must be told the person is suffering from anaphylaxis (pronounced ana-fill-axis).
If you are prescribed an adrenaline injector, you will need to know how and when to use it. Ask your GP or allergist for advice. You can also find help on the anaphylaxis website relevant to the injector you carry.
HOW DO I REDUCE RISKS?
Shopping - Always read food labels, even if you are buying a product you have eaten many times before as recipes and manufacturing methods sometimes change. Check both the inner and outer wrapping of multipacks.
All pre-packaged food sold within the EU, including the UK, must declare and highlight the presence in the ingredient list of 14 major allergens even if they appear in small quantities. These 14 allergens include peanuts and common tree nuts (almonds, hazelnuts, walnuts, cashew nuts, pecan nuts, Brazil nuts, pistachio nuts, macadamia nuts and Queensland nuts).
“May contain” warnings (sometimes known as advisory labelling) are used by food companies where there is a risk of cross-contamination during the production process. Advisory labelling is widespread and causes immense frustration to shoppers, but we believe these warnings should be heeded at all times and never ignored. Sometimes there are genuine risks. You may eat a product many times without a problem, but cross-contamination may have occurred the next time you eat it.
Eating out - Under EU law, food businesses selling catered or loose food are required to provide information about the presence of allergenic ingredients in their food. These include peanuts and tree nuts. You should question staff very directly, asking whether the nut you are allergic to is an ingredient of the food you have chosen or whether there is a risk of cross-contamination. Don’t be afraid to ask the waiter to check with the chef.
Cross contamination - this can occur in manufacturing process, storage or food preparation. At home, ensure that all work surfaces and chopping boards are cleaned thoroughly with hot soapy water. Use separate jars of jams or butter and separate utensils.
Allergy alerts - sometimes pre-packaged food have to be withdrawn or recalled from food suppliers including supermarkets and shops. These alerts are available from the Food Standard Agency (FSA) website, and it is free to subscribe for email or SMS text message. Allergy UK also has a free email Alert systema and you can contact Allergy UK for more details.
FOOD TIPS
- Watch out for satay sauce (made with peanuts), pesto sauce (which can contain tree nuts or pine nuts) and marzipan and praline (confectionery products made with nuts). Salad dressings may contain nut oils.
- Curries and other Eastern dishes are high risk because many of them contain peanuts or tree nuts and their presence may not be obvious if the food is spicy. Studies focusing on takeaway meals have shown that even when nut-free meals were ordered, a significant proportion still contained nuts.
- Foods likely to contain peanuts or tree nuts include the following: Cakes, biscuits, pastries, cereal bars, confectionery, ice cream, desserts, vegetarian products, salads and salad dressings. This list is not exhaustive.
- Watch out for peanut shoots as they are being sold in some UK shops. They can be used in stir-fry dishes and salads and could be mistaken for bean sprouts. Always read food labels carefully.
- Roasting and heat treatment do not reduce the allergenicity (capacity to produce an allergic reaction) of peanuts or tree nuts. In fact, roasting and heating peanuts (but not boiling) may actually increase their allergenicity
- Be careful when others share food with you particularly at school, parties and eating out
What Nutrients is my child missing out on by avoiding nuts and where can I get them from instead?
Peanuts and tree nuts are a good source of protein in a child's diet. Yet, if your child needs to avoid nuts of any type, he should not be at nutritional risk. Peanuts also provide a source of niacin, magnesium, vitamins E and B6, manganese, pantothenic acid, chromium, folic acid, copper and biotin. Your child can get these vitamins and nutrients by consuming a variety of foods from other food groups such as beans and lentils, olives and flaxseeds, chickpeas and sunflower seeds.
WHICH OTHER FOODS SHOULD I AVOID?
A significant proportion of people with peanut allergy is also allergic to tree nuts or will become allergic to them. Some people allergic to one tree nut, such as Brazil nuts, may become allergic to others, such as walnut. There is also the possibility of certain nuts coming into contact with others during food production.
So, is it best to avoid all nuts if you are allergic to one or two of them?
The answer to this question depends on what tests you have had. If you have been tested for specific nuts, your doctor or allergist will be able to advise whether it is possible to include certain nuts in your diet. If you do eat specific nuts, it is usually advisable to do so at home so you can better control any risk of cross-contamination. Eating nuts from the shells avoids the risk of cross-contamination from other nuts.
If you have not been tested for specific nuts, then play safe and avoid all nuts until you are able to be tested.
Legumes
Peanuts are actually legumes; however the number of people with peanut allergy who react to other legumes (such as soya, peas, chickpeas, fenugreek, beans and lentils) is relatively small. Care is needed, but most people find they can tolerate these other legumes without problems. Raise this with your allergy specialist for specific advice.
Lupin
If you are allergic to peanuts, watch out for lupin which is also a legume. If you are allergic to peanuts, you should discuss lupin with an allergist. You may be offered a test for lupin allergy. As you should be reading food labels scrupulously as a matter of course, you may wish to play safe and avoid any product containing lupin. Lupin flour is used as an ingredient in some baked goods, particularly those which are imported. Under European Law, lupin must be labelled when it appears in pre-packed food.
Sesame seeds
A proportion of children with peanut and tree nut allergy reported sesame seed allergy. If you are allergic to peanuts, you should discuss sesame with an allergist.
Other foods
People with nut allergy frequently ask if they should avoid certain foods with “nut” in the name – even those that are different to tree nuts. These include pine nuts, coconut, nutmeg and chestnut. If you are allergic to nuts and have never had a reaction to any of these foods, it is likely that they are safe for you to eat.
IS THERE A RISK THROUGH CONTACT THROUGH TOUCH OR SMELL?
People with peanut allergy are often concerned that casual contact with peanut - such as through touch or smell - could trigger a life-threatening reaction.
Researchers concluded that a very small amount of children with allergies would experience a severe reaction to this type of exposure.
IS THERE A RISK FROM PEANUT OILS OR NUT OILS?
Refined peanut oil will not cause allergic reactions for the majority of people with peanut allergy and if anyone does suffer a reaction it is likely to be mild. However, for a few years food companies have been compelled to declare refined peanut oil on food labels as well as unrefined. This enables people to make up their own minds whether to eat products containing refined peanut oil or avoid them.
Unrefined (also called crude) peanut oil is more likely to cause symptoms. Peanut oil (sometimes known as groundnut oil) may be used for frying in some fish and chip shops and this may be unrefined and therefore risky. Speciality oils such as walnut oil contain significant levels of protein and should be avoided.
Personal care products and medicines - Medicines, soaps, cosmetics and personal care products sometimes contain peanut or nut oils. It is difficult to determine the level of risk posed by these products, so we advise playing safe and avoiding them. Labels may show ingredients in Latin (e.g. arachis is the Latin name for peanut). Nut oils such as almond may be used for massage. They should be avoided by people with nut allergy
WHAT ARE THE RISKS DURING AIR TRAVEL?
Some people with peanut allergy report that they experience symptoms when peanut snacks are handed around to passengers with their drinks during air travel. In our view the most likely cause of these reactions is skin contact. If you touch a fold-down tray or some other surface that has previously been touched by a passenger eating peanuts, and then touch your eyes or mouth, you could have a reaction. To minimise the risk, you could carry “wet wipes” to clean surfaces as soon as you get on the plane.
Reactions caused by inhalation of peanut dust are thought to be unlikely. However, you must be guided by your doctor or consultant, and your allergy history. If you know you are at the high end of the risk scale (for example, you have reacted by inhaling peanut allergen in the past) then it would be sensible to contact the airline well in advance to request that peanuts are not distributed on your flight.
KEY MESSAGES
- Always be vigilant when food is around
- Check food labels
- Be proactive when eating out
- Carry prescribed medication everywhere
- Learn how and when to use your adrenaline auto-injector
- Ensure that asthma is well managed.
Reproduced by kind permission of Anaphylaxis.org April 2023
https://www.anaphylaxis.org.uk
USEFUL WEBSITES
The British Dietetic Association
https://www.bda.uk.com
Anaphylaxis Organisation
https://www.anaphylaxis.org.uk
Allergy UK
https://www.allergyuk.org
