Tree Nut Allergy

Tree nuts can cause a severe and potentially life-threatening allergic reaction (anaphylaxis). Allergic reactions can be unpredictable, and even very small amounts of tree nuts can cause a serious allergic reaction.

If you have a tree nut allergy, keep an epinephrine delivery device with you at all times. Epinephrine is the first-line treatment for anaphylaxis.

To prevent a reaction, it is very important that you avoid all tree nuts and tree nut products.

If you’re allergic to one type of tree nut, you have a higher chance of being allergic to other types. For this reason, your doctor may recommend you avoid all nuts. You may also be advised to avoid peanuts because of the higher likelihood of cross-contact with tree nuts during manufacturing and processing. These issues should be discussed and further evaluated by your allergist and specific allergy testing may be warranted. 

Tree nuts, as a food category, are one of the nine major food allergens that must be listed in plain language on packaged foods sold in the U.S., as required by federal law, either within the ingredient list or in a separate “Contains: Tree nuts [species]” statement on the package. This makes it easy to see if tree nuts are present in a food item. 

Note that in 2025, FDA guidance on food allergen labeling was updated, with important changes for tree nuts specifically. You can read more about the change here. The 12 tree nut species now specifically designated by the FDA guidance as requiring food allergen labeling are included in boldface in the list below. 
 

Avoid foods that contain tree nuts or any of these ingredients:

• Almond
• Artificial nuts
• Beechnut
• Black walnut, including hull extract (flavoring)
• Brazil nut
• Butternut (also known as white walnuts; not squash)
• California walnut
• Cashew
• Chestnut
• Chinquapin nut
• Coconut*
• Filbert/hazelnut
• Gianduja (a chocolate-hazelnut spread or mixture)
• Ginkgo nut
• Heart nut (also known as Japanese walnut)
• Hickory nut
• Litchi/lichee/lychee nut
• Macadamia nut (also known as bush nut)
• Marzipan/almond paste
• Nangai nut
• Natural nut extract (e.g., almond, walnut—although artificial extracts are generally safe)
• Nut butters (e.g., cashew butter)
• Nut distillates/alcoholic extracts
• Nut meal
• Nut meat
• Nut milk (e.g., almond milk, cashew milk)
• Nut oils (e.g., walnut oil, almond oil)
• Nut paste (e.g., almond paste)
• Nut pieces
• Pecan
• Pesto (often includes pine puts or walnuts)
• Pili nut
• Pine nut (also referred to as Indian, pignoli, pigñolia, pignon, piñon and pinyon nut)
• Pistachio
• Praline
• Shea nut
• Walnut (English or Persian)
• Walnut hull extract (flavoring)

Some Unexpected Sources of Tree Nuts

Allergens are not always present in these foods and products, but you can’t be too careful. Remember to read food labels and ask questions about ingredients before eating a food that you have not prepared yourself.

Tree nut proteins can be found in some surprising places, such as cereals, crackers, cookies, candy, chocolates, confections, energy bars, flavored coffee, frozen desserts, marinades, barbeque sauces and some cold cuts, such as mortadella.

Ice cream parlors, bakeries, coffee shops and certain restaurants (e.g., Chinese, African, Indian, Thai and Vietnamese) are considered high risk for people with tree nut allergy. Even if you order a tree nut-free dish, there is high risk of cross-contact.

Tree nut oils, such as walnut and almond, which often are not highly refined, are sometimes used in lotions, hair care products and soaps.

Crushed walnut shells may be used in “natural” sponges or brushes due to their durability. 

Some alcoholic beverages may contain nut flavoring, so consider avoiding these as well. Because alcoholic beverages are not yet federally regulated in terms of food allergen labeling, you may need to call the manufacturer to determine the safety of ingredients such as natural flavoring.

There are no documented cases of food allergy reactions to shea nut oil or butter. Therefore, it would be extremely rare for someone to react to one of these.

Argan oil is derived from the nut of the argan tree and has rarely been reported to cause food allergy reactions. While it is not a common food in the U.S., you will often find it in Morocco. Argan oil is also used in many personal care and cosmetic products available in the U.S. 

People with cashew allergy may be at higher risk for allergy to pink peppercorn (known as Brazilian Pepper, Rose Pepper, Christmasberry and others). This dried berry (Schinus, related to cashew) is used as a spice but is different from standard black pepper and vegetables with “pepper” in their name (e.g., bell peppers, red peppers or chili peppers).

*Coconut, the seed of a drupaceous fruit, has typically not been restricted in the diets of people with a tree nut allergy. However, for a period spanning October 2006 to December 2024, the U.S. Food and Drug Administration identified coconut as a tree nut requiring food allergen labeling. A 2023 study documented that roughly 1 in 260 Americans report symptoms consistent with an IgE-mediated allergy to coconut, although fewer than half of these individuals report receiving a physician diagnosis.³ 

An allergy to tree nuts tends to be lifelong. Research shows that about 9 percent of children with a tree nut allergy eventually outgrow their allergy.¹

Younger siblings of children who are allergic to tree nuts may be at higher risk for atopic disease. Every case is different and your doctor can provide guidance about food allergy testing for siblings if appropriate.