Managing Nut Allergies

Nut allergies are among the most common food allergies. Unlike many other food allergies, though, they are not outgrown with childhood. Only about 9 percent of kids with tree nut allergies leave them behind with age. Nut allergies can range from mild to severe. A mild reaction may include:

  • Hives
  • Wheezing and asthma
  • Runny or congested nose
  • Gut pain, throwing up, diarrhea

Nuts can also lead to more serious symptoms such as anaphylaxis which can, if untreated, lead to cardiac arrest (no heart rate) or respiratory arrest (no breathing).


People with allergies to one kind of tree nut frequently react to other kinds as well. Thus, doctors generally recommend using caution with all nuts where sensitivity to one type is demonstrated. Common tree nuts include walnuts, pecans, macadamia nuts, pine nuts, and hickory nuts. Peanuts are legumes—not nuts—but they are chemically similar to tree nuts, so people are often reactive to both.

Am I Allergic?

If you suspect a nut allergy, contact an allergist. (Note that allergies are often genetic, so if you’re at risk, your child may be, too.) Your doctor can perform a blood test or skin-prick food allergy test to determine your sensitivity to nuts. Your doctor may prescribe an epinephrine auto-injector—the first-line treatment for anaphylactic reactions. Doctors often recommend that you carry two of these at all times as a precaution.


Avoiding nuts is easier in today’s world than it used to be thanks to the Food Allergen Labeling and Consumer Protection Act (FALCPA). This legislation was passed in 2006 and requires food manufacturers to disclose major allergens on product labels. If you have a nut or peanut allergy, read labels closely, and don’t just assume that because a product was once nut-free it will always be. Sometimes manufacturers change ingredients or processing patterns, so be vigilant to make sure that products stay nut-free. In addition to products with obvious nuts, watch out for marzipan, pesto, and products with nut oils or nut flavorings (such as walnut hull extracts).


While avoidance has long been the only path for nut allergy sufferers, there is now a nut allergy treatment option known as sublingual immunotherapy (SLIT). SLIT uses oral allergy drops that absorb through cells in the mouth and help desensitize the body to the nut proteins that cause allergic reactions. Studies at Duke and Cambridge Universities helped attract public attention to ongoing use of this therapy. Those studies showed immunotherapy to be effective in reducing sensitivities to peanut allergies. Allergy treatment drops have also been shown to be effective with tree nuts. Talk to your doctor about prescribing sublingual immunotherapy for nut allergy treatment.

About The Author

Stuart H. Agren, M.D.

Stuart H. Agren, M.D. completed his undergraduate studies at the University of Utah and went on to earn his Doctor of Medicine from Tulane University School of Medicine in 1974. He completed additional training at L.D.S. Hospital in Salt Lake City, Utah and then established his private medical practice starting in 1975. Dr. Agren completed a mini-residency in Industrial Medicine at the Robert Johnson School of Medicine at Rutgers University and also completed training to become a certified Medical Review Officer.

Dr. Agren was the Medical Director at TRW and McDonnell Douglas in Mesa, Arizona and at Stauffer Chemical and Kennecott Copper in Salt Lake City, Utah. He also served as an adjunct faculty member at Arizona State University.

In his private medical practice, Dr. Agren specialized in family practice and allergy. In his work as a private practice allergist, he was one of the first doctors in the country to prescribe sublingual immunotherapy to his patients as an alternative to subcutaneous immunotherapy (allergy shots). He has also been a trailblazer in the field of food allergy treatment and research, developing a program to treat multiple food allergies simultaneously using sublingual immunotherapy. Dr. Agren has been featured on local CBS, NBC, and ABC news affiliates and won the peer-nominated “Top Doc” award from Phoenix Magazine.

After 20 years in private practice, Dr. Agren became the Founder and President of AllergyEasy, which helps primary care physicians around the country offer allergy testing and sublingual immunotherapy treatment to their patients. Over 200 physicians in over 32 states use the AllergyEasy program to help their patients overcome environmental and food allergies and asthma.