| Useful numbers
link will open a popup window with a print button. Click to
close the window.
for Nut free Products
| What is
Information and statistics courtesy of the Scottish Nutrition
& Diet Resources Initiative
Allergy to peanuts and other types of nuts and seeds is the most
serious form of food allergy. Peanut allergy is commonly
associated with allergy to tree nuts, especially Brazil nuts,
almonds, hazelnuts and walnuts. The reason why peanuts and nut
derivatives are so allergenic remains unknown, though the rise
in prevalence is probably due to increased exposure, because of
widespread use of peanuts in food manufacture. Sensitivity is
often extreme, with minute amounts of the allergen being capable
of triggering a rapid and severe type 1 allergic response.
This causes acute oropharyngeal swelling and
systematic circulatory effects which can result in asphyxiation
and fatal anaphylaxis. In the UK, about six deaths, usually in
young people, occur each year as a result of peanut anaphylaxis
and many near-fatal episodes occur. The prevalence of peanut
allergy is currently in the region of 1.3%.
It appears to be increasing and the age of onset getting
younger. It is increasingly being reported during the first year
of life. Nut allergy is less likely to be outgrown than most
other childhood allergies with only about 10% of sufferers
developing a tolerance to peanuts. It is much more likely to
resolve if it appears before the age of 3 years. It is less
likely to resolve if it develops in older children or adults, or
if other IgE mediated food allergies co-exist
Top of page
In allergic individuals, peanuts
are a well recognised cause of severe and rapidly occurring
symptoms, such as vomiting, diarrhoea, urticaria, angioedema
(swelling of the face, throat or skin), acute abdominal pain,
exacerbation of atopic eczema, asthma and anaphylactic shock. If
untreated, anaphylactic shock can result in death due to
obstruction of the upper or lower airway (bronchiospasm) or
hypotension and heart failure. This happens within minutes to
hours of eating the peanuts. The first symptoms may include
sneezing and a tingling sensation on the lips, tongue and throat
followed by pallor, feeling unwell, warm and light headed.
Severe reactions may return
after an apparent resolution of 1-6 hours. Asthmatics with
peanut sensitivity are more likely to develop life threatening
reactions. Peanuts are the most likely food to provoke fatal
anaphylaxis in children and adults but many other foods
(including tree nuts, seeds (e.g. sesame, sunflower), cow milk,
eggs, fish and shellfish) can also precipitate this.
Top of page
If you suspect you are having, or
might have an anaphylactic attack, SEEK
MEDICAL ASSISTANCE IMMEDIATELY. If you suffer an attack,
and have no medication such as Epinephrine to hand, dial 999
immediately. Even after administering Epinephrine, you
MUST STILL SEEK MEDICAL ASSISTANCE.
Symptoms can and often do reappear.
Top of page
Triggers and nut information
Medications: Watch out for an ingredient labelled "arachis"
or "arachis oil" on
medicines, shampoos and cosmetics, This is a label used to indicate the
presence of Peanuts or Nuts in the product. Always test new products on a small patch of skin
on your upper arm. Leave two days. If your skin doesn't react,
it's pretty safe to assume you are not sensitive to the product.
For peanut and nut
Peanuts and nuts
including Brazil nuts, walnuts, hazelnuts, almonds, cashews,
pistachio and pecans. Some of these may be called Ground nuts,
monkey nuts, earth nuts or goober nuts.
made from peanuts
including peanut butter, nut spreads, praline, noisette,
marzipan, frangipan, amaretto products, macaroons, Bakewell
tarts, almond essence, marron, Worcester sauce, satay sauce,
hydrolysed vegetable protein, nut containing or nut-coated
pressed ‘gourmet’ oils:
peanut oil, arachis oil, groundnut oil, walnut oil, almond oil,
could contain traces of peanuts/nuts but those most likely are:
cakes, biscuits, pastries, ice-cream, desserts, dessert
toppings, cereal bars, confectionery, savoury snacks, breakfast
cereals especially muesli type cereals, meat products,
vegetarian products and ready meals containing hydrolysed
vegetable protein, Oriental food, particularly Chinese, Thai and
Indonesian, sauces and salad dressings, mixed salads and wild
Probably originated in the Near
East but now grows in Southern Europe, Western Asia, California,
South Australia and South Africa. Almond oil is used for
flavouring and for skin care preparations and is extracted from
the kernel of the Bitter Almond. The Sweet Almond is grown for
nuts for eating and have the largest share of the nut trade
world-wide. Almond flour is available and it is possible to make
a nutritious nut milk from almonds.
A native of South America.
The nuts grow inside a hard, woody fruit rather like a coconut
shell which has to be broken open to expose the 12-24 nuts
inside. Brazils are high in fat, which causes them to go rancid
very quickly, and protein.
Native to America but now grown extensively in India and East
Africa. It will withstand rather drier conditions than most
other nuts. The nut grows in a curious way on the tree, hanging
below a fleshy, apple-like fruit. It is related to the mango,
pistachio and poison ivy.
The sweet chestnut is a native of South Europe but is planted
elsewhere extensively for both nuts and timber. The nuts can be
used in soups, fritters, porridges, stuffing's and stews, as well
as being roasted or boiled whole. Available fresh, dried, canned
- whole or pureed, or ground into flour.
The coconut palm is common in tropical regions all over the
world. The nut is covered in a fibrous outer coating on the tree
and all parts of the tree are useful, the trunks for timber, the
leaves for thatch, the fibrous husk produces coir - the starting
material for ropes and coconut matting - and the nuts are used
for food. Unripe nuts contain coconut milk. The nutmeat can be
eaten fresh or dried (desiccated or flaked coconut) and is also
available in blocks of creamed coconut. A valuable oil is also
extracted from the nut meat and used for cooking.
Hazel, also called Cob, is a common wild tree in Europe and
Asia and its nuts have been eaten by humans since earliest
times. The cultivated varieties are bigger and the filbert is a
similar but bigger species from SE Europe. Used in sweet and
savoury dishes, they are available whole, ground and flaked, or
made into oil and nut butter.
A native of NE Australia now also grown commercially in
Hawaii. Notoriously difficult to extract from their shells, they
are expensive but have a delicious creamy flavour and crunchy
Also known as groundnuts or monkey nuts, peanuts are actually
legumes. Of South American origin, it's now an important crop
all over the tropics and southern USA. It gets its name
groundnut because as the pods ripen, they are actually forced
underground. Peanuts are high in protein and contain 40-50% oil.
The oil is used in cooking, as salad oil, in margarines and the
residue is fed to animals.
A native of N America where it is used extensively in ice
cream, cakes, nut bread and confectionery.
These are the seeds of the Stone Pine, a native of the
Mediterranean region, but the seeds of various other pines are
eaten in various parts of the world including the seeds of the
Korean Pine or North American pinon tree. They are very
difficult to harvest, hence their cost. They are vital for pesto
Native to the Near East and Central Asia but has long been
cultivated in the Mediterranean region and more recently in the
Southern US. The kernels are green and are prized as much for
their ornamental colour as for their flavour.
The walnut is native to SE Europe and West & Central Asia but
is now grown in the UK, California and China as well. It is
grown for timber as well as its nuts. Walnut oil has been used
for centuries in the preparation of artists paints. The black
walnut is a native of North America, introduced into Britain in
the 17th century. The butternut is also from North America.
These two have much thicker shells than European walnuts.
Top of page
Advice courtesy of
- Minimise the risk by taking great care and
being vigilant. If you are food allergic, read labels like
Sherlock Holmes: look for the "hidden" allergen. You can
easily recognise a packet of peanuts but may miss the word
"groundnuts" in tiny print on the side of a tin of curry
sauce, or the Latin term arachis used to signify the presence
of peanut in pharmaceutical products.
- If you are food-allergic, be assertive about
asking for detailed information from manufacturers and
- Be particularly careful in restaurants, where
proprietors are under no obligation to list ingredients.
Question staff very directly. It may be necessary to speak
with a senior manager. Some restaurants have ingredient lists
available for you to check. You may wish to telephone the
restaurant in advance to ensure your allergy is taken
- Be alert to all symptoms and take them
seriously. Reach for the adrenaline (epinephrine) if you think
you are beginning to show signs of a severe reaction. Do not
wait until you are sure. Even if adrenaline is administered,
you will still need to get to hospital as soon as possible.
Someone must call an ambulance.
- Make sure others in your family know how to
administer the adrenaline kit - and when. Do not be frightened
of adrenaline. It is a well-understood drug. The dose you will
administer has very few side effects, which will pass quickly
in any case. However, if you have heart difficulties, discuss
these with your doctor.
- Develop a crisis plan for how to handle an
emergency. Get your allergist or GP to help. Have this written
out for family and friends - put it on the bulletin board at
home; carry one in your pocket. If a child is the person at
risk, make sure his teachers and friends' parents have a copy
- along with the adrenaline. Make sure everyone knows where
the adrenaline is when you go out, or when you are at home.
- Wear a Medic Alert talisman (details: 020
- Be open about your allergy problem with your
family, friends and colleagues. It's easy to avoid a Thai,
Chinese or Indian restaurant if everyone knows you are
allergic to peanuts.
Top of page
Because the majority of peanut allergies can
lead to anaphylactic attacks, we will deal only with
Epinephrine. There are other "alternate medications" out there
but in a life threatening situation, I am all for sticking with
what we know works.
The treatment for a serious allergic reaction is
adrenaline (also known as epinephrine). During
anaphylaxis, blood vessels leak, bronchial tissues swell and
blood pressure drops, causing choking and collapse. Adrenaline (epinephrine)
acts quickly to constrict blood vessels, relax smooth muscles in
the lungs to improve breathing, stimulate the heartbeat and help
to stop swelling around the face and lips (angioedema).
adrenaline injection kits are available on prescription for
those believed to be at risk. These are available in two
strengths - adult and junior. The injection must be given, as
directed, as soon as a serious reaction is suspected and an
ambulance must be called. If there is no improvement in 5-10
minutes, give a second injection.
Because this must be administered without delay,
patients known to be at risk often carry their own adrenaline
injection kits for use in an emergency.
The injection many doctors prescribe is the
EpiPen, an easy-to-use device with a concealed needle.
The EpiPen is available on prescription and distributed by ALK
-Abelló, 2 Tealgate, Hungerford, Berkshire RG17 0YT. Tel
A relatively new adrenaline injection kit called
Anapen is also available on prescription. It is
manufactured and distributed by Celltech Pharmaceuticals Ltd,
208 Bath Road, Slough, Berkshire SL1 3WE. Tel 01753 447690.
Both companies provide trainer pens for practice
purposes. For information on how to administer the EpiPen
(click here) and Anapen,
It is important to emphasise that even after
adrenaline is administered, medical assistance should be sought
urgently because the effects may wear off after 5 to 10 minutes
and the injection may have to be repeated.
In fact, doctors often prescribe more than one
injection kit so that if medical assistance is delayed, patients
may administer a second dose.
Top of page
Peanuts are legumes
Peanuts, unlike tree nuts, are not
nuts from a taxonomical point of view, but belong to the legume
family and are thus related to peas, beans and lentils. The
protein fraction of peanuts makes up 25-30% of the kernel.
Recently an increasing number of peanut proteins have been
identified as potential allergens. It is uncertain what causes
peanut proteins to be such strong allergens. Studies have shown
that the allergenicity of these proteins is very resistant to
thermal, chemical and proteolytic denaturation.
More than one child in 100 is
believed to suffer severe allergic reactions to peanuts, tree
nuts or both. A small but significant number are affected by
What about other Nuts or Legumes?
The peanut (Arachis hypogaea) is a legume but elimination of
other legumes (such as peas, beans and lentils) is not
appropriate unless sensitivity is suspected. Cross-allergenicity
has been demonstrated in vitro between the serum of peanut
allergic patients and several other legumes. However most peanut
allergic patients can eat other legumes and vice versa.
It is much more common for the peanut allergic individual to
react to tree nuts particularly brazil, almond, hazel. Adverse
reactions to other nuts are reported less often presumably
reflecting the frequency of consumption in the UK.
A recent American study reveals that of 122 nut allergic
children, 68 reacted only to peanuts, 20 only to tree nuts and
34 to peanuts and tree nuts. Here the most common tree nuts
implicated were walnut, almond and pecan. In common with
peanuts, tree nut allergy is rarely outgrown. If a peanut
sensitive individual has not yet been exposed to any tree nuts
then these should eventually be introduced singly and with
appropriate caution. Tree nut allergy can pose a serious problem
for peanut allergic people.
Top of page