When a child is diagnosed with a peanut allergy, the family is often advised to keep the child away from tree nuts. But is this necessary? Do peanut allergies always indicate a cross-reaction with tree nuts?
According to renowned food allergy expert Dr. Hugh Samson, cross-reaction is not likely, but it may be best to avoid tree nuts nonetheless.
Eliminating Peanuts and Tree Nuts
“If a toddler has a clear-cut, recent reaction to peanut and a positive skin test,” Samson explains, “I generally tell the parents that they should eliminate peanuts and tree nuts from the child’s diet. (I also obtain a peanut-specific IgE level so that I can get some idea of whether this toddler may fall into the 20 percent of young children who will outgrow their peanut allergy.)”
While there is little evidence to support the notion of cross-reaction – the proteins in peanuts and tree nuts are not similar – there are two reasons that justify an all-nut ban. Samson explains:
(1) Studies indicate that about 35 percent of American toddlers with peanut allergy will have (or develop) concomitant tree nut allergy. (2) In a young child, it is very confusing to distinguish the difference between peanut and ‘safe’ tree nuts, since many adults refer to both as nuts and are unaware of situations where peanuts may be included with specific tree nuts. We have seen too many accidents where a child receives peanut-containing products because of mis-identification, cross-contamination, or substitution with some peanut product. Consequently we think it is safer to avoid tree nuts until the child is old enough to understand the nuances of avoiding peanut contaminated foods.