Advice on nut avoidance

Which nuts to avoid?

Nuts can be hidden in many foods and it is important to check the list of ingredients very carefully.

Children

1. We often recommend avoidance of all nuts: peanuts and tree nuts (for example, Brazil nut, almond, hazelnut, walnut, cashew, pistachio etc). This does not include coconut or nutmeg which you may eat
2. In some children certain nuts are permitted. You will be told by the doctor which nuts to avoid

Adults

Adults may choose to avoid only the nut type to which they are allergic. However, other nuts or nut products may have been contaminated with peanuts (peanut is often substituted for other nuts such as almond, in Indian cooking sauces without being explicitly stated on the label). Therefore, it is often safer to avoid all nuts.

Check ingredients carefully

Manufacturers are obliged to highlight deliberately added peanut in the list of ingredients. Read the ingredients label which lists allergens (such as peanut or nuts) in bold. ‘Allergy information boxes’ are no longer permitted. Read the labels every time the product is purchased, as manufacturers may change recipes without warning. Labelling in the UK is of good standard, but labelling in some overseas countries is not regulated and can be misleading or inconsistent between different parts of the label, so check carefully.

Difficulties arise when food is not labelled:

For example:

• Delicatessen and bakery goods
• Eating out
• Visiting friends and relatives

It is essential, when enquiring about nut content in food to explain how serious the allergy is (to ensure you are not given incorrect or misleading information).

Studies show that take-away foods (such as Chinese, Indian and Thai) are highly likely to be contaminated with nuts, even if the allergy is discussed with the chef/cook before purchase. It is therefore preferable to avoid take-away food.

If in doubt, avoid the food.

‘May contain traces’ labelling

Increasing numbers of foods are labelled ' may contain traces of nuts' (where nuts are not included in the ingredient list). This means the product does not contain nuts, but the manufacturer may make another product in the same area, which does contain nuts. Some food labels will indicate the product has been produced in a factory that handles nuts. Most will take care to prevent contamination; the risk is therefore very small.

You need to decide how great you believe the risk is to you, and whether you wish to eat the product. Generally, it should be safe to eat these products. However, some foods are more likely to be contaminated because of manufacturing processes for example chocolates, cakes, biscuits and cereals. The risk is likely to be higher with these foods.

Nut oils

Peanut oils (also known as groundnut oil or arachis oil) come in two different varieties:

Walnut oil also contains significant amounts of protein and is used in cooking and salad dressings.

Labelling of these oils does not distinguish between a refined or non-refined product. It is therefore safer to avoid all such oils.

Most common causes of reactions

Children

Studies in our patients have demonstrated that a common cause of further reactions in younger children is eating snacks, for example, biscuits, cakes, chocolates and crunch bars.

Particular caution should be taken with these. Young children are particularly at risk when they are out of their parents supervision for example, at birthday parties, clubs or with grandparents. Extra caution should be taken at these times.

School children should avoid swapping food with classmates, and when ‘treat’ food is brought into the class from outside (such as a box of chocolates to celebrate a birthday) an alternative should be provided, unless the labelling indicates that it is safe to eat.

Teenagers

Should avoid take-away foods.

Adults

Restaurant meals are most likely to cause severe allergic reactions because nut content is often hidden, and large amounts are ingested.

Further Information

Supermarkets often provide lists of nut-free foods on request, but this information is of limited value, as it may be out of date, as recipes change.

The Anaphylaxis Campaign

This is a self-help group, which you may wish to join. It provides helpful information and keeps its members informed of changes to food labelling or product alerts.

Telephone: 01252 542029

Anaphylaxis website (opens in a new tab)

Address: PO Box 275, Farnborough GU14 6SX

References

1. Leitch, S., et al. 2005. Food allergy: Gambling your life on a take-away meal. International Journal of Environmental Health Research. 15: 79-87.
2. Kapoor, G., et al. 2004. Influence of a multidisciplinary paediatric allergy clinic on parental knowledge and rate of subsequent allergic reactions. Allergy. 59: 185-191
3. Ewan, PW. & Clark AT.2001. Long term prospective observational study of patients with peanut and nut allergy after participation in a management plan. Lancet; 375: 111-5
4. Clark, AT, Ewan, PW. 2008. Good prognosis, clinical features and circumstances of peanut and tree nut reactions in children treated by a specialist allergy centre. Journal Allergy Clinical Immunology; 122:286.