Photo of nuts The most commonly implicated tree nuts are walnuts, pecans, cashews and brazil nuts, and many people react to more than one.

Most parents send their children off to begin a new school year with excitement. But parents of children with severe food allergies typically feel real fear. Will their children successfully avoid the foods they are allergic to?

Infants and young children are most commonly allergic to cow's milk, eggs, soy, peanuts and wheat. Most of these reactions involve skin rashes (eczema) or gastrointestinal symptoms and are usually outgrown by age 3. However, allergies to peanuts, tree nuts, fish or crustaceans (shrimp and crab) are often more severe and are usually lifelong.

"About 1 percent of people in the United States have peanut or tree nut allergies," said Suzanne Teuber, professor of rheumatology, allergy and clinical immunology at UC Davis Health System. "For some, the reactions are truly life-threatening. The most commonly implicated tree nuts are walnuts, pecans, cashews and brazil nuts, and many people react to more than one. We are also seeing more sesame seed allergy in recent years."

Common symptoms

An allergic reaction typically occurs within minutes, but sometimes up to two hours after exposure. Symptoms may be mild, with just an itching sensation in the mouth, or may involve swelling of the air passages, accompanied by wheezing and respiratory distress, which can lead to death within minutes. Hives may appear on the skin, and gastrointestinal symptoms may be present, including vomiting, cramping or diarrhea. Blood pressure may drop, which can lead rapidly to loss of consciousness and death.

Allergic reactions can occur not just by eating the food, but through skin contact or even by inhalation. The daughter of a UC Davis physician first experienced a reaction on a flight when the stewardess opened bags of peanuts and passed them across her.

Allergic reactions often occur at school: in the cafeteria, during class celebrations, or while making craft projects, such as those using peanut butter or walnut shells.

"That's why it's essential that parents meet with their child's teacher and school principal to discuss the problem," said Teuber. "Make sure they can recognize an allergic reaction, and develop a written plan with the child's physician to deal with emergencies. This information should be shared with the rest of the school staff and cafeteria workers."

Teuber also advises parents to institute an "only-from-home" policy, in which the child knows to eat only food from home, and to provide teachers safe snacks to have on hand when other children get a special treat. "Too often, nuts or seeds are a hidden ingredient in cupcakes or cookies brought from stores or other people's homes," she said. "Even if nuts are not mentioned on a label, ingredients may be processed on machinery that previously handled nuts, leaving residues that can cause a reaction."

Children with a history of a severe reaction should wear a medical alert bracelet and have an epinephrine pen at school. The child and school personnel should be instructed in its use. The pen should be administered at the start of an allergic reaction, and 911 should be called. Many people mistakenly wait and see if severe symptoms develop before taking action. Such delays have had tragic outcomes. Even if the child seems to recover, symptoms can recur, and the child should be under observation for several hours in an emergency room.

"No one should underestimate the dangers of severe food allergies," said Teuber. "But parents should also not be paralyzed by fear. Teach children to recognize what is safe. Practice with them ways to be assertive in discussing their problem, refusing forbidden food, and asking for help if they feel they are having a reaction. Help them at an early age to develop lifelong skills to cope confidently with this potentially life-threatening condition."


The Food Allergy & Anaphylaxis Network is a national organization dedicated to helping families and individuals cope with severe allergies. Check out their Web site at or call (800) 929-4040 during normal working hours on the East coast.