Ask Dr. Marla: Can I use other nut spreads when the school has a no-nuts policy?

By Dr. Marla Shapiro on November 13, 2012
My kids’ school has a no-nuts policy, but I thought kids with peanut allergies are not usually allergic to tree nuts. Can I use other nut spreads like almond butter in my kid’s lunch?


The short answer is No. Although peanuts are a ground nut and a peanut allergy is different from a tree nut allergy, there are many similarities. In fact, many peanut allergy sufferers also have tree nut allergies.

For more information, I turned to the Food Allergy and Anaphylaxis Network. According to the network, one study showed that from 1997 to 2002, the incidence of peanut allergy doubled in children. Peanuts can trigger a severe allergic reaction. Symptoms range from hives, eczema, digestional discomfort to anaphylaxis, a potentially fatal constriction of the airways and swelling of the throat, known as anaphylaxis.

There is also allergy to tree nuts, which include, but are not limited to, walnut, almond, hazelnut, cashew, pistachio, and Brazil nuts. These are different than peanuts, which are a legume, or seeds, such as sunflower or sesame.

Peanut allergy or tree nut allergy are usually considered to be life long. However, recent studies indicate that up to 20 percent of children with peanut allergy will outgrow it the condition.

We usually advise children with peanut allergies to avoid all nuts for two reasons:
  • to prevent accidental peanut exposure (because people can’t reliably distinguish different nuts);
  • because up to one third of peanut allergic children will later develop a tree nut allergy.

When we feel we are ready to know, we can test individual nuts to be sure. But tree nut allergy can also develop “out of nowhere” in 30- and 40-year-olds, so we can’t say someone is safe forever. Depending on the age of the child, testing for almond allergy might open the door for almond butter (if it is peanut-free), and negative hazelnut tests might lead to eating chocolate hazelnut spreads such as Nutella.

Many experts advise patients who are allergic to some tree nuts to avoid peanuts and other tree nuts because of the high likelihood of cross-contact at processing facilities, which process peanuts and different tree nuts on the same equipment. Many nut butters are produced on equipment used to process peanut butter, therefore making it somewhat risky. Further, a person with an allergy to one type of tree nut has a higher chance of being allergic to other types.

Originally published in ParentsCanada magazine, November 2012.

By Dr. Marla Shapiro| November 13, 2012

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