in a nutshell (nut allergies)

Nut allergy is one of the most common types of food allergy in children and adults.  It involves the immune system responding abnormally to proteins in nuts (peanut or tree-nuts).  Unfortunately nut allergy tends to persist with fewer than 20% of children outgrowing their allergy.

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Signs and symptoms can vary from mild to severe and include:

  • itching, tingling sensation of lips, tongue & throat
  • swelling of lips, tongue, eyes and face
  • urticaria (itchy rash)
  • diarrhoea
  • vomiting
  • wheeze
  • hoarseness
  • lightheadedness & dizziness
  • swelling & tightening of throat & airway
  • stridor (rasping noise on breathing in)
  • collapse due to drop in blood pressure
  • anaphylaxis

Avoiding nuts

Any nut may cause an allergic reaction but reaction to peanuts is the most common.  The best treatment is total avoidance of all nuts, including:

  • Peanut
  • Almond
  • Cashews
  • Hazelnut
  • Pecans
  • Pistachio nuts
  • Walnuts
  • Brazils
  • Chestnuts
  • Macadamia nuts

Avoiding nuts means more than just not eating them.  It also means not eating any foods that might contain tree nuts or peanuts as ingredients.  Foods most likely to contain peanuts or tree nuts include:

  • Nut butters or pastes e.g. Peanut butter
  • Breakfast cereals and cereal bars e.g. muesli, crunchy nut cornflakes
  • Cakes, biscuits, pastries e.g. almond slice, chocolate chip cookies
  • Desserts e.g. trifle, pecan pie
  • Marzipan, praline, frangipane
  • Ice cream e.g. pistachio
  • Chocolate, sweets e.g. nut toffee, fruit and nut chocolate, nougat
  • Chinese, Indian, Thai, Indonesian foods e.g. Satay, curries, stir fries
  • Vegetarian products e.g. Veggie burgers, nut cutlet
  • Salad and salad dressings e.g. Waldorf salad

Some very sensitive children may have a reaction through touching nuts even if they do not actually eat a nut containing food. Very sensitive children may also react if they are touched or kissed by others who have just eaten nuts.  A worrying prospect for parents of school aged children as peanut butter sandwiches are a South African lunch box staple.

Mixed-Nuts-Deluxe

Other foods

Some plants have the term “nut” in their name but are not true nuts. These include:

Palm nuts/palm kernels

Pine nuts/pine kernels

Coconut

Nutmeg

Legumes and lupin: peanuts are part of the legume family (which includes beans, peas, lentils, lupin and soya beans).  Lupin flour may be added to commercially made foods such as pastry, pasta, pizza and crumbed foods, particularly foods imported from Europe.

It is not necessary for children with nut allergy to avoid these plants or seeds such as sesame seeds unless it is suspected they are also allergic to them.

Nut oils

Unrefined (cold pressed) peanut, walnut or other nut oils should be avoided. These oils are commonly used in ethnic food restaurants such as Indian, Thai, and Chinese restaurants or take-aways.

Food Labels:

The best way to ensure a food is nut free is to read the label.  South African food labelling laws (DoH R146) currently require that labels must clearly state whether nuts (as well as other common allergens) are an ingredient in a food product. These laws apply only to packaged, manufactured foods and drinks sold in SA.  This law currently does not apply to foods sold loose (e.g. from a bakery, delicatessen, butcher or cafe) or foods packed for direct sale (e.g. sandwich bars or in-store bakeries).  Manufacturers occasionally change their ingredients, therefore it is always safer to recheck the ingredients list.  If you are uncertain about the safety of a product, do not eat the food until you have checked with the manufacturer.

Many foods are now being labelled “may contain traces of nuts”.  These foods have been produced in an area where nuts are also used. Even if the food itself does not appear to contain nuts, there is a risk that it may have been contaminated with nuts used in other foods. Due to this risk, it is recommended that foods labelled “may contain traces of nuts” be avoided. For similar reasons, products produced in in-store supermarket bakeries should also be avoided.

Living with nut allergies can be difficult as your child may face the risk of having a reaction on a daily basis.  You should obtain an antihistamine syrup (available without prescription) and keep this available at mealtimes.  Your doctor may provide an adrenaline injection if your child is considered to be at high risk of a severe allergic reaction.  Make sure you/your child carry this medication with you at all times.

Article by Paediatric Dietitian Lindsay Archibald-Durham