According to South Carolina-based salon owner Rosanne Kinley, who’s also past president of the National-Interstate Council of State Boards of Cosmetology, sweet almond oil is commonly used by manicurists not only because it’s effective but because “it has an extremely long shelf life.”

But what if you are allergic to almond or other tree nuts? Is it safe?

Allergists told Allergic Living magazine that it’s difficult to know just how much almond protein is in these oils after the manufacturing process. It’s likely there isn’t much, they say. And if that’s the case, and the product is only being applied to the nail surface, “it would be unlikely to be of any significant risk,” says Dr. Scott Sicherer, a New York City allergist.

That said, Sicherer notes that soaking your fingers in the oil could cause skin irritation. And, if you are extremely allergic to almond – meaning that you react even to very small amounts – and if bite your nails or cuticles (meaning that you might ingest the oil), your allergist may counsel complete avoidance.

Discuss the matter with your own doctor. But Allergic Living suggests a simple solution in the meantime: Bring some safe-for-you oil (olive, grape seed, canola, safflower, coconut) to your next manicure to use as an alternative.

At age 7, Alexandra took such delight in being a Girl Scout Brownie. She wore her Brownie vest proudly, earned “Try-It” badges with enthusiasm and sold an impressive number of cookies during the annual sale. The kid was as dedicated as anyone else in her Brownie troop and she deserved this summer adventure. But I wasn’t sold. Was the camp ready for a child with life-threatening allergies to peanuts and tree nuts? Would she be safe?

Since her food allergy diagnosis at age 4, I had vowed to support Alexandra in enjoying normal life activities. Still, summer camp presented several unknowns, including a distant location and a new group of caregivers. Plus, my daughter was still very young. I argued with myself about the pros and cons of each decision. If I let her go to camp, was I risking her health? If I didn’t let her go, was I risking her self-esteem?

Before my husband and I had made a decision, I happened to be chatting with another Girl Scout mom. She was concerned about camp, too. “My daughter is so small,” she explained. “I’m afraid if she sinks in the pool, no one will see her.” That’s when it hit me. Every parent worries about something. Worrying is not exclusive to parents of kids with food allergies. No matter what your situation, it’s not easy to let go. I decided to learn more about the program.

What I found out was encouraging. The camp didn’t serve peanut butter, employed a full-time EMT and trained its staff in EpiPen usage. After more discussion, we decided to give it a go.

When the first day of camp rolled around, my daughter’s eyes sparkled with happiness as she boarded the bus and waved goodbye. And when I picked her up at the end of her first day, she was tanned, tired and happy. I relaxed just a little. Maybe things would be just fine.

But on the second day, the phone rang. I could see it was the camp. My heart raced as I choked out a greeting. “This is the medical office,” said the voice on the line. No! My heart was pounding so hard that I barely heard the next sentence. “Alexandra scraped her foot on the bottom of the pool and was bleeding, so we gave her a Band-Aid. It’s camp policy to report any injuries that result in bleeding.”

I exhaled and hung up. Minor bleeding was definitely preferable to a food allergy emergency. A scraped foot? No problem.

On Day 4, another call from the medical office. I tried not to panic. Turns out, it was just another minor injury, once again resolved with a simple Band-Aid.

On the last day of camp, the Girl Scout leader called me from her cell phone. I was sweating as I answered, convinced that this had to be “The Call.”

“Is Alexandra OK?” I blurted out. “She’s fine!” was the cheerful reply. Apparently, my daughter had been offered a snack at a campfire celebration and wanted to double-check with me before eating it. I was giddy with relief as I thanked the troop’s leader and gave a thumbs-up to the treat.

When I hung up, I couldn’t do anything but laugh. After all of my concern and repeated phone calls from camp, we had made it through the week without a single food allergy emergency. Even better, I now had solid evidence that my daughter was checking foods before eating them – a huge step in her food allergy independence.

That summer, we both gained a lot of confidence about the future. Our camp experience taught me that even though food allergies require planning ahead and certain precautions, they do not define my daughter.

Another important thing I learned? Along with the EpiPen, never forget the Band-Aids.

Jenny Kales is the author of the blog The Nut-Free Mom and a freelance writer who covers parenting topics. She and her husband and two daughters live near Chicago. To comment on this article or to suggest your own Our Story, e-mail us at editor@allergicliving.com.

First published in Allergic Living magazine.
To order that issue or to subscribe, click here.

© Copyright AGW Publishing Inc.

Read also:

- Managing a Peanut Allergy
- Dating with Allergies
- Flying Tips
- Nut Allergies at School

Allergen

Where It Hides

Alternate Names

• baked goods, crackers
• cereals
• granola bars, trail mixes
• marzipan
• calisson (marzipan-type candy)
• Pad Thai
• satay sauce
• curry sauces
• chili and trout amandine
• gianduja and giandula (chocolate blended with hazelnuts)
• tree nut oils
• pralines
• salad dressings
• spreads: almond paste, nut butters, chocolate-nut spreads (Nutella)
• nougat (e.g. torrone)
• pesto (often has pine nuts)
• liqueurs (e.g. Amaretto usually contains almonds)
• natural flavorings and extracts (e.g. almond extract)

• anacardium nuts
• filberts (hazelnuts)
• nut meats
• pinon
• Queensland nut (macadamia)

Sources:
-ImmunoCAP
-Canadian Food Inspection Agency

How were we to wrestle her hard-earned nutty goodies away without a pitched battle? Somehow, our heartfelt “it’s for your own good” speech was always lost on her, and tears would make little paths through her face makeup.

We needed a plan. And so, the Great Pumpkin came to the rescue. It was a fine tale I concocted, an allergic cross between the famous Charles Schulz pumpkin patch tale and the Easter Bunny.

In my version, a large, orange benefactor visits children with nut and peanut allergies each Halloween. On Halloween night, Mom and Dad would leave all the nut-tainted candy in a bag in the front hall, and the Great Pumpkin, pleased with this sacrifice, would leave a gift in its place.

A tradition was born, and it was a good thing, as Geneva and her younger sister Paris didn’t eat their own weight in candy. Instead, they would receive a puzzle or a movie.

The Great Pumpkin, of course, grew fat at her desk at the office, which wasn’t so good, but let’s move along, shall we, to the year of the orange one’s near miss ….

***

It was the Halloween of 2003, a brutally cold, wind-howling prairie evening in Saskatoon, with temperatures plunging to -25 degrees C (-13 degrees F).

Geneva was dressed as a punk rocker with fuzzy purple earmuffs to match her purple hair (it was just too cold to be cool), and Paris was dressed up as a leopard (basically a spotted snowsuit). My husband Bruce was dashing as a green-skinned demon with red horns.

I stayed home to dole out treats, while the kids and my husband headed out, returning after just 45 minutes with an astonishingly large bag of goodies.

We read all the labels, culled the offending candies and at the end, hung a hefty sack inside on the front doorknob for the Great Pumpkin. The kids trundled off to bed. And so did we.

In the morning, Geneva came bounding into our room in tears. “Mom, the Great Pumpkin didn’t come last night!”

Ack! I knew I had forgotten something when I turned off the lights the night before. Blinking the sleep from my eyes, I tried to think quickly.

“Oh, dear. That’s my fault, sweetie, I locked the door last night and … he couldn’t get in. I usually leave the door open on Halloween so he can come inside.”

Geneva looked crestfallen. By now her sister had also shuffled into our room. Geneva relayed the bad news. Paris’s face fell.

“You know, I bet he left your present with our pumpkins on the front step,” I said. “Why don’t you girls go get dressed in some warm clothes and we’ll go outside and look.”

The kids dashed to their rooms. “Wear lots and lots of clothes!” I yelled.

I elbowed Bruce in the ribs. “Quick. We don’t have much time!”

The study, published in the European journal Allergy, found that in a group of 141 selected children with peanut or cashew allergy, the cashew group was more likely to experience shortness of breath, wheezing or cardiovascular symptoms during reaction than the peanut group. (This was despite the fact that a majority of the children with peanut allergy also had asthma.)

The Study and Findings

In 2007, researchers paired 47 children whose worst ever allergic reaction was to cashews with 94 children whose worst ever allergic reaction was to peanuts. Two children with peanut allergy were matched to every one child with cashew allergy and comparison criteria also included sex,

The study revealed that 22 per cent of children with cashew allergies experienced shortness of breath and/or collapse compared to 1 per cent of children with peanut allergies.

Also, while oral antihistamines were most frequently used as treatment by both groups, epinephrine was administered much more often in the children with cashew allergies. (Thirteen per cent of the cashew allergic compared to 1 per cent of the peanut allergic.)

What This Means

This study is important because: it shows the severity of tree nut allergies in general, the cashew specifically and raises the issue of the need for better public awareness.

The researchers advised fellow health-care professionals that “the diagnosis of cashew nut allergy increases the odds of a severe reaction and requiring intramuscular adrenaline and should also be considered in the risk assessment.”

As well in terms of managing the allergy, they noted that cashew can be a hidden food. “Cashew nuts present a considerable hazard, being hidden in a wide variety of commonly ingested foods, such as Asian meals, sweets, ice cream, cakes, chocolates and they are increasingly used in commercially prepared pesto sauce instead of pine nuts,” they wrote.

awareness in the public of the seriousness of tree nut allergy is not as high as awareness of peanut allergy.   it places importance on tree nut allergies despite the fact that peanut allergies tend to get more attention in scientific studies and the media. While it is now very common to see “Peanut-Free” logos on snack foods and candy bars, it is rare to see the same for tree nuts.

Further, we now suggest that the diagnosis of cashew nut allergy increases the odds of a severe reaction and requiring intramuscular adrenaline and should also be considered in the risk assessment.

It has been suggested that cashew avoidance is easier than peanut avoidance (10, 14); nonetheless it is not straightforward. A recent study showed that 10/37 (27%) of nut-allergic children were unable to correctly identify the type of nut to which they were allergic (15). Cashew nuts are commonly sold as the whole nut alone, or packaged with other nut types. Cashew nuts present a considerable hazard, being hidden in a wide variety of commonly ingested foods, such as Asian meals, sweets, ice cream, cakes, chocolates and they are increasingly used in commercially prepared pesto sauce instead of pine nuts. Specific information on how to achieve nut avoidance should always be provided.

The study found that cashew allergies, specifically, are on the rise and are no longer uncommon. Furthermore, it can be just as challenging to avoid cashews as it is to avoid peanuts since cashews can hide in desserts, ice creams, trail mixes and other unexpected places.

More on this study, click here.

Reading labels is a way of life when you or a member of your family has a tree nut allergy. Before eating anything in a package, be sure to read the label carefully. Look for hidden sources of nuts and alternate names for it.

Also be on the lookout for precautionary statements. These are statements that indicate an allergen may be in the food, due to cross contamination during processing. Examples of precautionary statements include: “May contain tree nuts” and “Manufactured in a facility that contains tree nuts.”

Allergists generally advise people with tree nut allergies to avoid all products that include precautionary statements about their allergen. If you are ever uncertain about whether a food product is safe for you, call the manufacturer to confirm. When in doubt, don’t eat it.

In Canada, new regulations have been proposed that would require food manufacturers list priority allergens in plain language on packaging, rather than using alternate names (ie: Bertholletia excelsa instead of brazil nut).

The ingredients within listed ingredients that are priority allergens would also have to be shown. For example, manufacturers couldn’t simply list “flavouring” if the flavouring included a priority allergen, such as almond extract.

More on Canada’s New Food Allergen Regulations.

In the United States, the Food Allergen Labeling and Consumer Protection Act went into effect in 2006. FALCPA requires manufacturers to use plain language when listing priority allergens, and to declare all allergens either in the ingredient list, or in a “Contains:” statement at the end of the list.

The allergens included in this regulation are milk, eggs, fish, shellfish, tree nuts, wheat peanuts and soybeans. These regulations do not include sesame and mustard, unlike the proposed Canadian regulations.

Separate legislation requires companies to declare sulphites if they are present at more than 10 parts per million, or if they had a technical or functional effect in the food.

Both Canada and the United States are studying ways to regulate the precautionary statements used on packaged food labels.

A major study in the United States recently found that cases of tree nut allergy in children increased significantly in a decade, from 0.2 per cent in 1997 to 1.1 per cent in 1998. The same study found that more than 3 million Americans now have a peanut or nut allergy.

In Canada, recent research has shown 1.59 % of children have an allergy to tree nuts, and 1 per cent of adults live with the allergy.

In fact, food allergy in general is on the rise in North America and other developed countries. In Canada, an estimated 7.5 per cent of people have food allergies, representing more than 2.5 million people. In the United States it’s estimated that 12 million Americans (or just under 4 per cent of the population) have food allergies.

Here are the rates of some of the major allergens in Canada and the U.S.

CANADA

Source: Surveying Canadians to Assess the Prevalence of Common Food Allergies and Attitudes towards Food Labelling and Risk (SCAAALAR) study. Published in the Journal of Allergy and Clinical Immunology, June 2010.

UNITED STATES

Peanut, Tree Nut or both:
Children -  2.1 %
Adults – 1.3 %

Source: US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. Published in the Journal of Allergy and Clinical Immunology, June 2010.

Clarke and her colleagues surveyed close to 10,000 Canadians in the Surveying Canadians to Access the Prevalence of Common Food Allergies and Attitudes towards Food Labelling and Risk (SCAAALAR) study. They found that 3.2 per cent were allergic to one or more of peanuts, tree nuts, shellfish, fish and sesame. Of those, “at most, only 38.7 per cent reported receiving epinephrine,” while having a moderate to severe reaction, says Clarke.

It’s not clear whether these individuals had auto-injectors and simply didn’t use them, or if epinephrine wasn’t available to them. Either way, Clarke told Allergic Living that the numbers concerning.

“We certainly know that there is a problem here in the proper management, because one would like to see that almost everybody who is reporting a moderate to severe reaction would receive the epinephrine.”

Clarke says her team has dug into the data a little further to look at what type of people are likely to carry an auto-injector, but results of that analysis are not yet available.

The SCAAALAR study, which is partially funded by the allergy research network AllerGen, also looked at attitudes towards food labeling, particularly precautionary statements on food packages (such as “may contain” advisories), and attitudes of general population toward risk of food allergy in the context of environmental health risks. Results will be available in the coming months.

Highlights from SCAAALAR study

Allergies in the Canadian population

Published in the June 2010  issue of the Journal of Allergy and Clinical Immunology. View here.

1. Refined Oil: When a tree nut oil is refined, the chances of the proteins of that food being in the oil are low. While pure refined oils (various tree nuts and also peanut) exist, it is always safer to avoid nut oil completely since there is no definitive way for a consumer to know how much protein is in that oil.

2. Unrefined Oil: Nut oils that are cold-pressed,” “unprocessed,” “expelled,” “extruded” are unsafe for nut allergic individuals. These are much more likely to contain nut and/or peanut proteins.

3. Where Nut Oils are Found: It’s easy enough to avoid nut oils on your own shopping list, but also be mindful of them when eating out. In restaurants, be sure to  ask waiters specifically about salad dressings and sauces; chefs sometimes use nut oils to enhance flavors.

Nut oils are also found in some cosmetics and body-care products. Pay specific attention to lip balms, lipsticks and lip glosses since those are coming in direct contact with your mouth.

Sources include: Dr. Antony Ham Pong, allergist

When someone with a tree nut allergy ingests their allergen, even a trace amount, that person is at risk of a severe allergic reaction, called anaphylaxis. An anaphylactic reaction includes more than one of the body’s systems, such as the respiratory tract, gastrointestinal tract, the skin and cardiovascular symptom.

Symptoms of an allergic reaction include tingling in the mouth, swelling of the tongue and throat, itchy skin or hives, difficulty breathing, abdominal cramping and vomiting. In a severe anaphylactic reaction, a person may experience a drop of blood pressure, loss of consciousness and even cardiac arrest and death.

One of the issues in managing tree nut allergies is that reaction symptoms can vary greatly. A person may have minor symptoms on one occasion, but anaphylaxis on a next exposure.

Because tree nut allergy reactions can be severe, it is important that a person with this allergy carry an epinephrine auto-injector (EpiPen or Twinject) with them at all times. Research has shown that a small number of people (about 9 per cent) may outgrow their tree nut allergies.

Prevalence

In Canada, 2009 statistics show that 1.14 per cent of the population is allergic to tree nuts, while in the United States 1.1 per cent of children have the allergy and 0.5 per cent of adults. Tree nut allergy is on the rise: the 2008 telephone survey in the U.S. that found 1.1 per cent of children are allergic to nuts, compare that to just 0.2 per cent of children reported as allergic to nuts in 1997.

More on Tree Nut Allergy Statistics

Next Page: What is a Tree Nut?