Tree Nut Allergy

Tree nuts include Brazil nuts, cashews, almonds, pine nuts, hazelnuts, pecans, walnuts, macadamia nuts and pistachio nuts. They are one of the top ten allergens. Tree nut allergy is one of the most common food allergies in both children as well as adults.

What is tree nut allergy?

Tree nut allergy is a hypersensitivity reaction to proteins found in tree nuts occurring due to the malfunctioning of the immune system. The allergic reaction occurs almost immediately after exposure to dietary substances in tree nuts.


The primary cause of tree nut allergy is an abnormal response of the immune system. After consumption of dietary proteins present in tree nuts, the immune system responds adversely by not recognizing the proteins as harmless. Instead, the proteins are perceived as harmful pathogens. The immune system launches an attack against them by producing immunoglobulin E (IgE) antibodies. During the consecutive consumption, the antibodies engulf the pathogens and signal the immune system to release histamines and other chemicals. These chemicals trigger allergic response in the body. In other words, tree nut allergy is an IgE-mediated immune response.

Symptoms of tree nut allergy

The onset of tree nut allergy symptoms occurs as soon as there is an exposure to tree nuts. Tree nut allergies can be quite severe. In fact, anaphylaxis reaction is quite common in people detected with tree nut allergies. Individuals detected with mild form of tree nut allergy develop the following symptoms:

  1. Abdominal pain
  2. Nausea or vomiting
  3. Diarrhea
  4. Difficulty to swallow
  5. Itchy tongue, mouth, throat, lips and skin
  6. Itchy and watery eyes
  7. Nasal congestion or runny nose
  8. Shortness of breath
  9. Wheezing

Severe anaphylactic reaction with tree nuts

Severe anaphylaxis symptoms include the following:

  • Impaired breathing
  • Constriction of airway
  • Abrupt drop in blood pressure
  • Loss of consciousness
  • Shock

Tree nut allergy usually tends to sustain life-long but according to reports, approximately 9 per cent children outgrow their allergy with time.

Diagnosis & Tests

As soon as the symptoms persist, there is a requirement for formal diagnosis to get it confirmed whether the person is suffering from tree nut allergy or not. There are basically two diagnosis methods to confirm the presence of allergen. Those are discussed below:

Skin prick test

This is a diagnosis method wherein a small skin portion of the patient with the suspected allergen is pricked with the help of a needle. Thereafter, a small amount of allergen extract is incorporated into the pricked portion and waited till any bumps appear. Appearance of red bumps indicates that the person is allergic to tree nuts.

Blood test

This is basically a diagnosis method to check for the presence of immunoglobulin E antibodies in the bloodstream. The level of these antibodies increases in the bloodstream when there is any sort of threat from foreign invader. The likeliness to have tree nut allergy is directly proportional to the amount of antibodies.

Risk factors

Talking about the factors that put people one-step ahead in terms of developing tree nut allergy, there are quite a many. Some of them are discussed in detail:

  1. Younger siblings of children those who are suffering from tree nut allergy are at considerable risk of developing allergy to tree nuts.
  2. Cross contact of peanuts with tree nuts or one type of tree nut with another poses great risk of developing allergy to other types of tree nuts.
  3. Prevalence of asthma and eczema heighten the risk of developing allergy to tree nuts.
  4. If one type of food allergy already persists in an individual, there is a likeliness to develop allergy to tree nuts as well.
  5. According to reports, 9 per cent children have been found to outgrow their allergy at a later point of time. However, it has been found that sometimes the mitigated allergy revives much later in life. Therefore, past allergy definitely acts as a risk factor.


Tree nut allergy can pose fatal complications in life. Diagnosis at an initial stage right after the onset of symptoms is crucial. Proper diagnosis leads to proper treatment. In case of any negligence, mild symptoms of tree nut allergy transform into severe, life-threatening anaphylaxis reaction, which can be quite dangerous for an individual. Nevertheless, tree nuts are potential allergens and are known for causing anaphylaxis in most of the people.

Treatment of tree nut allergy

The first line of treatment is complete avoidance of tree nuts. Allergist would decide on the avoidance of particular types of tree nuts or all types depending on the intensity of allergic reaction. Mostly, it is recommended to avoid all tree nuts to keep the patient on the safer side. This might well be termed as preventive treatment. It prevents the allergy from worsening.

When allergic symptoms develop, dosages of anti-histamines are mandatory to bring the situation under control. Anti-histamines are available both as prescribed and over-the-counter drugs. They act as great relievers.

Anaphylaxis symptoms cannot be treated only with anti-histamines. Epinephrine injections should be administered to the patient with severe anaphylaxis symptoms. In fact, as an effective suggestion, people prone to anaphylaxis should always carry auto-injectors of epinephrine along with them to immediately combat the reaction. But a trip to the emergency room is mandatory for a patient of anaphylaxis for proper monitoring of symptoms and complete follow-up.

Diet and caution

Diet plays an inevitable role in managing every food allergy including tree nut allergy. To be on an elimination diet, it is important to be aware of the sources of tree nuts. Many food products have tree nuts as hidden ingredients. Such food products are cereals, cookies, chocolates, frozen desserts, flavored coffee, energy bars, cold cuts, crackers, marinades, candies, barbeque sauces, etc. Therefore, it is important to feel free and be inquisitive about the ingredients involved in the dish ordered for while dining out at some restaurant. While purchasing any food product, reading labels should be inculcated as a habit. In case of any discrepancy, one should contact the manufacturer for a deeper insight into the ingredients.

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