Tree Nut Allergy In Children: Full Guide To Symptoms, Treatments, And More

Tree Nut Allergies In Children: Symptoms, Treatments & Everything Else A Mama Needs To Know

March 4, 2020 Updated September 30, 2020

tree nut allergy
Katherine Chase/ Unsplash

When it comes to allergies in kids, most of us — even if our kids don’t have allergies — take extra precautions around peanuts. Got a bake sale for your daughter’s class? You probably double-check all of the ingredients to avoid legumes. Sending a sandwich with your son for his fourth-grade field trip? You pack ham and cheese instead of PB&J. And that’s fantastic! But while peanut allergies are often discussed and considered, there’s another common “nut” allergy in kids: tree nut allergies.

Of course, peanut and tree nut allergies are different because peanuts aren’t true nuts. But we’ll get to that distinction later. For now, we’re going to start with an exploration of what tree nut allergies are, how a child can be diagnosed for them and, most importantly, what to do in the event of an allergic reaction to tree nuts.

To best paint the big picture about raising a child with tree allergies, we sought insight from the experts: doctors, dietitians, allergy specialists, even dentists! What we ended up with is a one-stop-shop for all information pertaining to tree nut allergies in children. You have enough to worry about, mama; we hope the following comprehensive explainer helps lighten your mental load at least a little.

What is a tree nut allergy?

When your child has a food allergy, they have a medical condition in which their immune system creates an abnormal response. This means the immune system launches an attack on proteins in the food that the body would normally find harmless. When this happens, it manifests as an allergic reaction.

For a child with a tree nut allergy, their immune system is triggered by the proteins found in tree nuts. The most recognized tree nuts include almonds, hazelnuts, pecans, walnuts, and cashews, but there are many lesser-known varieties that families with tree nut allergies will have to learn and be on the lookout for (more on that in a minute).

Can a child be allergic to some tree nuts and not others?

Yes! Some people with tree nut allergies must strictly avoid all tree nuts. Other people can actually partake of certain tree nuts but not others. That’s a call you’ll have to make with your child’s pediatrician or allergy specialist.

Adrienne Urban, food allergy/special diet blogger at Whole New Mom, learned after her son was diagnosed with tree nut allergies that although his reaction to most tree nuts is extreme, it isn’t across the board. “Yes, this can happen. In fact, this is the case with our son,” she shared. “He is deathly allergic to all tree nuts except for almonds and macadamias.” To ensure her son’s safety, Urban purchases nuts for her family from suppliers without cross-contamination. “It takes a little homework, but it’s worth the peace of mind!” she said.

Having said that, Dr. Tania Elliott, allergist and spokesperson for the American College of Allergy, Asthma and Immunology (ACAAI), pointed out to Scary Mommy, “There is a high degree of cross-reactivity among tree nuts, which is why allergists often recommend avoiding them altogether.”

What is the difference between a tree nut allergy and a peanut allergy?

An allergic reaction to any food is the same at the core — an abnormal immune system response. However, a tree nut allergy is a true “nut” allergy whereas a peanut allergy is not. This doesn’t mean that one is better or worse than the other (they all suck!). It simply means that peanuts aren’t actually nuts; they’re legumes. Interestingly, between 25 to 40 percent of people who are allergic to peanuts also react to at least one nut, according to the ACAAI.

What does a tree nut allergy look like in a baby, toddler, child, and teen?

Janilyn Hutchings, Certified Professional in Food Safety (CP-FS) and StateFoodSafety‘s in-house food safety specialist, emphasized that allergy symptoms can vary by individual. She said, “In general, the symptoms of a tree nut allergy include: hives around their mouth, face, or torso (if the reaction is more severe, children may also get hives on their arms or legs); red and itchy skin; stomach pain; nausea; vomiting; diarrhea; and/or anaphylactic shock.”

Most babies aren’t exposed to tree nuts that early in life and severe reactions from ingesting breast milk (after a mother has eaten tree nuts) aren’t common. When a child is old enough to talk, said Hutchings, what they say may clue you into a potential tree nut allergy. According to Hutchings, this might sound like: “My tongue is hot, itchy, or heavy,” “There are bumps or hair on my tongue,” “My throat feels thick,” “My lips or throat feel tight,” “There’s something stuck in my throat,” “My mouth feels funny,” or “My ears feel itchy.”

How long does a tree nut allergy reaction take to develop?

A tree nut allergic reaction may be immediate, but it could also be delayed and present hours after ingestion. “A tree nut allergic reaction is typically what is called an IgE mediated reaction and involves the release of a product in your body called histamine. This release causes most of the symptoms often associated with an ‘allergic reaction,'” Dr. Jay Lovenheim, D.O., F.A.A.P., of Lovenheim Pediatrics, told Scary Mommy.
Also good to know? Even after it seems as though your child’s reaction has subsided, a second wave of symptoms may strike one to several hours later.

What is anaphylaxis?

When an allergic reaction is extreme, it’s known as anaphylaxis. Per Elliott, this is a severe, life-threatening reaction to an allergen that impacts multiple organs. Most of the time, it is accompanied by swelling or hives in addition to a combination of the following: the lungs, by constricting the airways that make breathing difficult, swelling in the GI tract that causes vomiting, and/or dilation of the blood vessels, causing a drop in blood pressure and, in severe cases, shock.

As such, it’s imperative that anyone with a tree nut allergy carries an epinephrine auto-injector at all times. “If a child has a tree nut allergy and displays symptoms, an epinephrine auto-injector is the first line of defense and the only thing to stop an allergic reaction from progressing. It should be given immediately,” emphasized Elliott.

What is an epi-pen?

In the child allergy world, you’ll often hear mention of an epi-pen. This is shorthand for the epinephrine auto-injector referenced above by Elliott. It’s called a “pen” because, well, that’s basically what it looks like — it’s like the love-child of a giant pen and a syringe. It’s small, portable, and could very well save your child’s life in the instance of an extreme reaction.

If you ever do have to administer the epi-pen to your child (or if anyone else does), you’ll need to call 9-1-1 immediately after. Depending on what you’re advised, you’ll either wait for first responders to arrive or take your child to the nearest emergency room. This is critical since symptoms can come back hours later. Medical supervision is always necessary after an epi-pen injection.

Note: Epi-pen is a generic term for an epinephrine auto-injector. It is derived from the brand EpiPen. Other brands include Adrenaclick and Auvi-Q.

Can a child take anything else for tree nut allergies?

In the case of a severe reaction — so, if anaphylaxis is suspected — you’ll have to administer your child’s epi-pen. Unfortunately, it’s simply not safe to make judgment calls about using over-the-counter medications or seeking alternative treatment once a child with a tree nut allergy shows signs of a reaction.

“We do not recommend antihistamines such as Benadryl as first-line treatment for food allergy. It will only help skin symptoms, and it will not prevent a reaction from progressing,” explained Elliott. “Steroids take hours to kick in and should not be administered in the setting of an acute reaction.”

How common are tree nut allergies?

In short, much more common than you may think! “Tree nut allergy is one of the most common food allergies seen in any parts of the world,” shared Loveheim. “Its prevalence is reported to be as high as 1 to 2 percent of the population. In fact, studies have shown that 35 percent of those with a peanut allergy may also have a tree nut allergy.”

Lovenheim noted that while children may be allergic to some tree nuts and not others, walnut is the most reported tree nut allergy, followed by cashew and almond.

How do you test for a tree nut allergy?

“Tree nut allergy is usually diagnosed based on a history of reactions after eating a tree nut, and may be confirmed using a blood test or a skin test called a prick test,” said Lovenheim. “Due to the higher than preferred rates of false-positive results from blood tests and prick tests, physicians will not make the diagnosis based on the test results alone. A history of a reaction after ingestion is usually required. If no such reaction is noted by the family, then a patient is often asked to ingest a small amount of tree nut under the supervision of an allergist. This is called an oral food challenge.”

This sort of food challenge should always be performed in a proper medical setting and never attempted at home.

What foods should a child with a tree nut allergy avoid?

Thanks to the Food Allergen Labeling and Consumer Protection Act (FALCPA), U.S. packaged food items are required to clearly state on the label if they contain tree nuts. This stipulates that the specific nut be identified.

Bottom line? Reading labels need to be a mandatory part of your lifestyle from the minute your child is diagnosed with a tree nut allergen. You’ll notice some food labels have jargon to the effect of “made in a facility where tree nuts are processed.” Again, whether or not your child needs to avoid those foods is something you should discuss with your child’s allergist. It’s always better to err on the side of caution, though, and steer clear.

A child with tree nut allergies should clearly avoid foods and products containing tree nuts, as well as items that are presumed to cross-react. It’s confusing; we know.

But in general, the items someone with tree nut allergies should stay away from include but aren’t limited to: almonds, artificial nuts, beechnut, Brazil nuts, butternut, cashews, chestnuts, chinquapin nut, coconut (deemed a nut by the FDA, but generally determined if safe to consume by a tree nut allergy doctor), filberts/cob nuts, hazelnuts, gianduja (creamy mix of chocolate and chopped toasted nuts), ginkgo nut, hazelnut spread (like Nutella), hickory nuts, litchi/lichee/lychee nut, macadamia nuts, mandelonas (peanuts soaked in almond oil), marzipan or almond paste, mortadella (an Italian sausage made with pistachios), nangai nut, natural nut extract, nougat, nut butters, nut oil/pieces/meal, nut paste, pecans, pesto, pili nut, pine nuts/pignolia, pistachios, praline, shea nut, and walnuts.

Also, some natural extracts — think pure almond extract or wintergreen extract — contain tree nuts and should be added to the no-touchy list. Even barbecue sauces, cereals, and ice creams can contain tree nuts, which further reinforces the need for reading labels.

If you have any doubts about what’s safe and what isn’t, call your child’s allergist ASAP. They’re the best resource a parent of a child with nut allergies has, and they can fill in any blanks for you along the way.

Are there any non-food items to watch out for?

You might understandably presume that you don’t have to worry about tree nuts outside of the kitchen or things that your child consumes. Unfortunately, that isn’t necessarily the case. Per dental hygienist and Toothbrush Life blogger Kelly Hancock, parents of kids with tree nut allergies should take some possible precautions when visiting the dentist.

“Many dentists will place fluoride varnish on the teeth to help protect from cavities. There are certain brands of fluoride varnish that contain resin tree sap material in them, which can cause a reaction in someone with a tree nut allergy,” Hancock explained. “Always disclose your full health history when visiting any medical doctor or dentists so they can take precautionary measures.”

You should also know that foods that aren’t regulated by the FDA, cosmetics and personal care items, and prescription and over the counter medicines and supplements are not covered by FALCPA law.

Other non-food related items that may contain tree nuts or tree nut allergens include hacky sacks and bean bags and food for birds as well as domestic rodents, like hamsters and gerbils.

Are tree nut allergies genetic?

Yes and no. “If one parent has a history of allergies, there is a 50 percent chance of their children having allergies. If both parents are allergic, there is a 75 percent chance of their children being allergic,” said Dr. Jacqueline Jones, ear, nose, and throat specialist and author of Medical Parenting: How to Navigate Health, Wellness & The Medical System with Your Child. That’s the “yes.”

Now for the “no.” Elliott underscores that the above statistic speaks to allergies in general, not tree-nut-specific allergies. “While allergies tend to run in families, it is impossible to predict whether a child will inherit a food allergy,” she said.

Is there anything you can do to prevent tree nut allergies?

Per Jones, “There is currently no cure for food allergies, nor are there medications to prevent reactions.” Having said that, studies suggest that being proactive in your child’s early stages could make a difference.

“If your infant is at risk for developing a food allergy — for example, if they have family members with allergies or severe eczema — it has been proven that if you introduce tree nuts before six months of age, the risk of developing a tree nut allergy is greatly decreased,” Allie Gregg, a registered dietitian with a practice in Kansas City, Missouri, shared with Scary Mommy. She continued, “There are several baby food brands that are available specifically for introducing high allergen foods early to babies. A few of the brands include My Peanut, SpoonfulOne, and Inspired Start.”

And not to beat the same old drum here, but by now it goes without saying that you should always consult your child’s pediatrician and/or allergist before making any big dietary decisions for your food-nut-sensitive child.

Do tree nut allergies ever go away?

Well, it isn’t entirely outside of the realm of possibility. According to Jones, approximately 10 percent of children with tree nut allergies may outgrow them over time. Common sense mandates that children with significant tree nut allergies should undergo allergy testing with a specialist prior to re-introducing any tree nuts into their diet. However, it’s more likely that a tree nut allergy will follow a child into adulthood.

Still, there are things you can (and should) do to manage the condition. “The most important of these is avoiding coming into contact with food proteins that cause an allergic reaction,” advised Jones. “Read food labels to ensure that you don’t eat foods that contain [tree nuts]. Always ask about ingredients when eating at restaurants or when you are eating foods prepared by family or friends. Be sure to have an Anaphylaxis Action Plan and carry your epinephrine auto-injector with you at all times.”

How do I talk to other parents or party hosts about my child’s tree nut allergies?

When we’re being taught our manners growing up, it’s instilled in us not to be extra trouble. That is doubly true for young girls and women (hopefully not for our children’s generation). But niceties, decorum, and etiquette go out the freaking window when your children’s health and well being are involved. With that said, you might still not know how to approach other parents or even family members about keeping your little one’s dietary needs in mind for any playdates, holiday get togethers, or birthday parties.

The best advice is to keep it simple and discuss it ahead of time. The good thing is that for other parents in your kid’s school, going nut or allergen-free is not that big of a deal. Nearly all daycares and schools are already enforcing those rules anyway. And with so many regular or specialty bakeries offering nut-free treats, it’s not that hard to make that request.

You might come across an issue when you talk to elderly family members, or others without young children. The CDC reports that instances of food allergies in kids went up a whopping 50 percent between 1991 and 2011, so parents of adult children probably need extra talking to and information.

How do I talk to my child about their food allergy?

Dealing with a food allergy is stressful for adults and children alike. Unlike their parents, however, kids don’t always have the vocabulary necessary to express how they feel. When talking to your child about their food allergy, the best course of action, always, is to be as honest as you can depending on your child’s age.No matter their age or maturity, you never want to unduly scare them or downplay the seriousness of their situation and medical needs. Most importantly, when speaking to younger kids, keep it simple and direct, using age-appropriate talking points like the following:

— You have a food allergy, and anything with tree nut can make you feel very sick. Use simple terms like “safe food’ and “unsafe food”.

— Don’t have food that has not been approved of by mommy or daddy.

— Tell us or your teacher if your tummy hurts, you don’t feel good, or feel funny.

— In addition, you can also point out allergens like nut packages and snacks in stores so they can familiarize themselves with what the allergen looks like.

Parents can use resources like books, videos, games, apps, and music specifically tailored to teach kids about food allergies. For example, the American Academy of Allergy, Asthma and Immunology has created a Mr. Nose-It-All character to help children understand and identify their allergy and symptoms through play.

What are some resources for parents of children with food allergies?

If your child has food allergies, an allergist might offer medical support, but not the daily emotional support parents so often need. Which is why joining an online community or Facebook group for parents with children who have allergies can help you navigate the day-to-day or living with a food allergy in the house. There you might get tips on resources, doctor recommendations, and even recipes. With so many Facebook groups out there, you might even find one that touches on your child’s specific allergy.

Food allergy podcasts for parents

Looking for guidance beyond the books and games? Thankfully there’s an entire world of food allergy podcasts parents can turn to for more information. Here are just some that might help:

Conversations From The World of Allergy — This official podcast from AAAAI is an invaluable source of information for parents figuring out school, play, and life all while they deal with their child’s food allergy. With experts and guests offering tips and advice, it’s not meant as individual medical advice, but as examples of what has worked for other families and what might work for you. Per the podcast’s official website: “This podcast is not intended to provide any individual medical advice to our listeners. We do hope that our conversations provide evidence-based information.” All specific medical queries should obviously always be addressed to your child’s allergist.

Exploring Food Allergy Families — This podcast touches on the realities of living with food allergies and its impact on the physical, mental, and emotional health of all involved. With tips and hacks offered by the show’s host and guests, it could serve as a helpful resource for parents.

Related: 17 Things Parents Of Allergic Kids Think Are Normal