Managing peanut and tree nut allergies

B y Caroline Shannon-Karasik

There’s no denying it: peanuts and their BFF peanut butter are classic foods. Without peanuts, a jelly sandwich would seem incomplete and the Cracker Jacks in “Take Me Out to the Ball Game” – an ode to America’s favorite pastime – would get a stand-alone shout out.

For those who are allergic to peanuts and tree nuts, however, the sentiment is simply nonexistent. According to the Food Allergy and Anaphylaxis Network (FAAN), an estimated 1.8 million Americans have an allergy to tree nuts, and peanut allergies are continually on the rise. Tree nuts include walnuts, almonds, hazelnuts, cashews, pistachios or Brazil nuts. Peanuts, on the other hand, are considered a legume – like sunflower seeds – and do not fall into the tree nut category. As with many food allergies, one of the most common incidents for someone to run the risk of contamination is when ingesting a prepackaged food or a dish that is being prepared by someone else. While this can be an issue in restaurants or when eating at someone’s home, cross-contamination is also an issue in school settings.

“[Schools] are rising to the task of working closely with families and students at risk for food-induced allergy and anaphylaxis,” said Mireille Schwartz, founder and Chief Executive Officer of the Bay Area Allergy Advisory Board. “The most important aspect of the management in the school setting is prevention.”

FAAN points out that peanuts and tree nuts are common to a number or food items, including:

• Salad dressings

• Vegetarian burgers and meat substitutes

• Pasta

• Honey

• Pie crust

• Fish dishes

• Pancakes

• Barbecue sauce

• Glazes and marinades

• Sauces such as hot sauce, pesto and gravy

• Tuna and chicken salads

Cross-contamination during the manufacturing process is also not uncommon, therefore making a number of prepackaged goods off limits for those who are allergic to peanuts and tree nuts.

“No two allergic reactions are exactly the same, so it’s best to be prepared even if an allergy has only resulted minor symptoms in your past,” Schwartz said, “and you should strongly suspect an allergy if symptoms begin almost immediately after eating. Allergic reactions can cause swelling of the tongue and the throat, and allergies can trigger severe asthma attacks.”

Schwartz advised people to be on the lookout for red flag symptoms, including angioedema (swelling of the face, throat, genital area, arms or legs); hives (itchy welts that resemble insect bites and may appear in small groups or over large areas of the skin); or anaphylaxis (a severe, multisystem reaction that can cause difficulty breathing, changes in heart rate and blood pressure and loss of consciousness).

“Anaphylaxis is a medical emergency,” Schwartz said. “If you or a friend experience any of [these symptoms] – breathing difficulties, difficulty swallowing, fainting, loss of consciousness or dramatic changes in heart rate – after exposure to a potential allergen, call 911 immediately. If you have been previously prescribed an auto injector of epinephrine (commonly also referred to as an ‘Epi Pen’), administer it at once.”

Food allergy expert Michelle Risinger points out, much to the disadvantage of those who suffer from true food allergies, movies like Hitch or Monster-in-Law have “popularized this idea by portraying an allergic reaction as comical and non-life threatening.

“The most frequent response food-allergic people receive is to encounter individuals who do not understand the true seriousness of an anaphylactic reaction and the very limited amount of time one might have before death occurs,” Risinger said. “In a similar vein, it is also commonly misunderstood even if a meal does not contain nuts in the ingredients, that does not mean it may not have picked up nut traces in the kitchen.

Risinger said in some restaurants and cafeterias, young people are not taken as seriously as adults when they explain their allergies. Therefore, it is important to clearly and adequately explain the scope of an allergy, including the dangers of cross-contamination. If a food-allergic person ever feels like an allergy is not being taken seriously, it is important he or she ask to speak with a manager or school official.

Again, if you have been diagnosed with peanut and tree nut allergies, it is important to make people aware that there are distinct differences between the two. It should never be assumed an item is tree nut-free because it is peanut-free, and vice versa.

What about you? What are your concerns about food allergies? Send me an email!


Caroline Shannon-Karasik is the author of The Gluten-Free Revolution and a certified health coach. She is also the author of the popular gluten-free blog, Her writing and recipe development has been featured in several publications, including, VegNews, Kiwi and REDBOOK magazines. Find Caroline’s book at Caroline can be reached at

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