Avoiding nuts can be even more challenging than it appears. According to the advocacy nonprofit Food Allergy Research & Education (FARE), nearly 3 million people in the United States report having peanut and tree nut allergies, and reactions range from itchiness and hives to anaphylaxis and death. For these people, the biggest concern isn't about eating something so obviously peanut-filled as a PB&J. Much of their worry centers on hidden nuts in foods that don't come with labels: an eggroll that was sealed with peanut butter; a bakery cookie made with almond flour; chili sauce with nuts in it.
Not all peanut-containing foods are easy to spot. Although the Food Allergen Labeling and Consumer Protection Act mandates that peanuts and tree nuts (along with six other major allergens) must be disclosed on a product, there are no such guidelines for food prepared in restaurants, bakeries, or kitchens, where there are, of course, no labels.
Registered dietitian Marion Groetch, M.S., R.D., director of nutrition services with the Jaffe Food Allergy Institute at Icahn School of Medicine at Mount Sinai in New York City, works with many patients who have severe food allergies. She instructs them on how to read labels and encourages them to try to lead as normal a life as possible, while also being safe. She says: "Always be prepared for an accident. Make sure you have epinephrine with you at all times. Always read product labels and be aware of areas that might be of high risk." And look out for these traps.
1. Bakery shops. Cookies and baked goods carry a risk of cross-contamination. Even if you're selecting something as seemingly plain as a sugar cookie, it's possible that the cookie or the equipment it was made on came into contact with nuts. What's more, a number of bakeries use almond flour rather than (or in addition to) wheat flour.
2. Ice-cream parlors. Cross-contamination is an issue here, too. You may think you're ordering a simple scoop of vanilla, but because the ice-cream scoop has been used in other flavors, traces of nuts could get into your child's treat. Even if you request that the server use a clean scoop, traces from earlier in the day could have gotten into the ice cream. The same goes for toppings.
3. Restaurants with ethnic cuisines such as Asian, African, Indian, and Mexican. Peanuts and tree nuts are commonly found in different ethnic foods, including satay, panang curry, pad Thai, and some korma sauces. Many Chinese restaurants cook with various nuts and may use peanut butter to seal eggrolls. Woks are typically not washed between orders, so even if a dish free of peanuts and tree nuts carries a risk of cross-contamination. And nuts are part of a number of Mexican dishes, such as mole and enchilada sauce.
4. Sauces or mixed meals, such as casseroles in restaurants. A variety of sauces use peanut butter or peanut flour as a thickener. Be particularly aware of peanuts in chili, chili sauces, and even pasta sauces. With casseroles, you never know exactly what you're getting, so when you're dining out, simple meals, simply prepared, are safer. Groetch says that if your child has very severe food allergies or multiple food allergies, you're often better off not ordering anything off the menu at all. Instead, make a request like, "Can you order me a chicken breast in olive oil and garlic cooked in a separate pan, using a clean pan and clean utensils?"
5. Desserts in restaurants. Nuts are common ingredients in desserts, so there is a risk in ordering one that has a hidden peanut or tree nut ingredient (ground nuts, nut flour, or a nut ingredient in a sauce) or has come in contact with peanut or tree nuts. Fresh fruit is a safer option.
All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.