Nut Allergy

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.

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.

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/.

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 list outline nut products and common sources of nut products that should be avoided.

Nut products

Foods and ingredients that indicate peanuts and other nuts

• Almonds
• Macadamia nuts
• Mixed nuts
• Ground nuts
• Walnuts
• Nutella spread and other nut pastes
• 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
• 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)
• Crushed nuts on top of desserts e.g. cakes, fruit buns, ice cream (peanut/other nuts)
• 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, macarons, Florentines – (almond)
• 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.

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.

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.

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.