Nut allergy

Peanuts and tree nuts (cashew, walnut, almond, pecan, pistachio, Brazil nut, hazelnut, macadamia) contain a protein that can cause an allergic reaction in some children. It is possible to be allergic to one or several nuts.

For most people the diagnosis of nut allergy is life-long. The only current treatment for nut allergies is total dietary avoidance. Although nuts are a good source of protein, iron and some vitamins, removing them from the diet will have little effect on overall nutritional intake for most children.

 

Severity of nut allergy

The severity of allergic reactions to nuts can vary. In highly sensitive children, reactions can be severe and even tiny amounts (‘trace’ amounts) can trigger symptoms.

Mild reactions can include swelling, skin rashes or hives, stomach pains and vomiting. Mild reactions may occur through skin contact or nut contamination on toys or kitchen equipment.

Nuts are a common trigger of a very severe reaction called anaphylaxis. This reaction involves the respiratory (breathing) system and the cardiac (heart) system and can involve difficulty breathing, throat swelling or a drop in blood pressure. Anaphylaxis is potentially life threatening.

 

Allergy action plan

Due to the severity of allergic reactions to nuts, many child care centres choose to implement a ‘nut free’ policy, particularly if there are children attending that have known nut allergies.

Avoiding nuts can be challenging because nut products are used as ingredients in many commercial food products that are not obvious sources of nuts.

Allergy action plans are recommended to advise staff what to do if a known allergen is ingested. The action plan should be developed with the child’s family and treating team (doctor, allergist, paediatrician) and be approved and signed by a recognised health professional involved in their care.

On enrolment, centres should request written documentation of confirmed allergies from the child’s treating team. Parents should document exactly what their child can and cannot tolerate to avoid confusion and this should be written on the allergy action plan.

Specialised anaphylaxis action plans are essential for children that have anaphylactic reactions to nuts.

For information about developing an allergy action plan refer to Allergy policy and allergy action plans or the Australasian Society of Clinical Immunology and Allergy (ASCIA)* website http://www.allergy.org.au/.

 

Avoiding nuts

In Australia all packaged foods must include a food label with an ingredients list. By law, all potential food allergens (peanuts, tree nuts, seafood, fish, milk, eggs, soybeans and wheat) must be clearly identified, no matter how small the amount.

If an ingredient includes nuts, this should be listed on the ingredients list. For example, if a product contains praline it should be listed as ‘praline (almond)’ or ‘almond praline’. Products may also include a statement near the ingredients list which says ‘This product contains nuts’.

When purchasing packaged items, carefully check the food label and ingredient list for nut products. Check these each time the product is purchased, as ingredients and processing techniques may change. Be aware that other words may be used for peanuts and tree nuts in other countries (e.g. peanuts may be referred to as ‘monkey nuts’ or ‘ground nuts’).

The following tables outline nut products and common sources of nut products that should be avoided.

Foods and ingredients that indicate peanuts and other nuts

Almonds

Macadamia nuts

Mixed nuts

Ground nuts

Walnuts

Hazelnuts

Praline, Baci (hazelnut)

Satay sauce

Pecans

Pistachio nuts

Marzipan (almond)

Peanut flour

Brazil nuts

Chestnuts

Arachis (peanut)

Rhen flakes (peanut)

Peanuts, peanut butter, peanut paste

Cashews, cashew nut paste

Nutella spread and other nut pastes

Peanut oil

Common sources of peanuts and other nuts

Peanut butter, other nut butters or pastes

Textured or hydrolysed vegetable protein

Friands and flourless cakes (often contain almond meal)

Flavoured cheeses (fruit and nut, walnut)

Peanut and satay sauce (peanut based)

Chocolate spreads e.g. Nutella (hazelnut)

Nut filled chocolates (can be peanut or other nuts)

Baklava, Greek pastry (walnut or peanut)

Marzipan icing, confectionery or cake decorations (usually almond based)

Praline, fine nut (usually hazelnut) product added to desserts and chocolates

Nut biscuits such as Amaretti, macaroons, Florentines – (almond)

Crushed nuts on top of desserts e.g. cakes, fruit buns, ice cream (peanut/other nuts)

Breakfast cereals

Muesli bars and health bars

Energy mixes or trail mix

Fruit crumble mix

Christmas cakes and puddings

Nougat and fudge

Pesto

Salad dressings

Fruit cake icing (marzipan)

Waldorf salad (walnuts)

Asian style meals

Worcestershire sauce

Products at high risk of being contaminated with peanuts or other nuts

Takeaway foods

Restaurant meals

Asian foods

Chocolate

Commercial biscuits

Commercial ice creams

Commercial breakfast cereals

Animal and bird feeds

Nuts can be found in some non-food sources such as:

  • some skin creams and nappy lotion
  • some sunscreens.

 

‘May contain traces of nuts’

This statement is used by manufacturers to indicate that products may be contaminated with peanuts or other nuts through processing and packaging. At present ‘May contain traces of nuts’ is a voluntary statement and there are no clear guidelines to direct food companies how and when it should be used.

The wording of the statement ‘May contain traces of nuts’ makes it difficult to determine level of risk as a product that does not contain the statement may be no safer than a product that does.

The chance of significant allergic reaction through contamination during processing is unlikely. However, for children with severe or anaphylactic reactions to nuts, these products should be used with caution. As a precaution, families should document whether or not children can tolerate products with ‘May contain traces of nuts’ statements so that services are clear about which products can and cannot be provided.

 

Do all nut products need to be avoided?

Some foods that come from the same family as peanuts and some foods with the word ‘nut’ in their name can be well tolerated by children with nut allergy. The table below can be used as a guide to determine foods that do not necessarily need to be avoided.

Food

Does it need to be avoided?

Peanut and other nut oils

Best avoided for severe allergies. Refined nut oils (not cold pressed) can be safe for people with nut allergies as the protein part of the nut is removed during processing. However, it can be difficult to determine how well the oil is processed, and these products are best avoided in cases of severe allergy.

Coconut

No. Coconut comes from the seed of the drupaceous fruit.

Nutmeg

No. Nutmeg is obtained from the seed of the drupaceous fruit.

Water chestnuts

No. Despite their name, water chestnuts are not a nut and come from the edible portion of a plant root.

Beans, legumes and pulses

No. Although soy, lentils and peas come from the same family as peanuts, most people with peanut allergy can eats these foods safely.

Sesame seeds

Not always. However, allergy to sesame seeds is common in people with a peanut allergy. Hummus dip and tahini contain sesame seeds.

 

Food preparation

Children with severe reactions to peanuts and other nuts may have a reaction due to:

  • contamination of cooking surfaces (e.g. barbecues, bench tops) with nuts or nut products
  • contamination of kitchen utensils (e.g. knives, kitchen sponges) with nuts or nut products
  • contact with someone who has recently eaten or prepared (e.g. touched) nuts
  • contamination of food storage containers (e.g. margarine tubs) with nuts or nut products.

Your centre’s allergy policy should address these issues and include strategies to reduce contamination with nuts or nut products during food preparation (e.g. strict hand washing procedures after meals to avoid transfer of trace amounts of nuts from hands to toys and craft materials).

Picking nuts out of foods will still leave trace amounts of nut protein in the product and is not recommended.

Nut free policies are another way of reducing contamination from nut products. Visit Developing an allergy policy and allergy action plans for more information.

 

Adapted with permission from: Peanut and tree nut allergy, Department of Allergy and Immunology, Royal Children’s Hospital Melbourne, November 2007. Other references: Nut allergy, Women’s and Children’s Health Network, Women’s and Children’s Hospital SA, March 2011.

* The ASCIA website includes personal action plans for allergic reactions and for anaphylaxis. These are medical documents that can only be completed and signed by the patient’s treating medical doctor and cannot be altered without their permission.