The following information is intended to help people with allergy to almonds to manage the condition successfully. The information is intended as general guidance. If you know or believe you are allergic to almonds, it is important to visit your GP and seek a referral to an allergy clinic.
Allergy to almonds can be one of two types.
The first type is considered to be a primary food allergy. A person with this type of allergy will have had previous contact with almonds, resulting in their immune system producing antibodies to almond. This is known as sensitisation. In some of these people, further exposure to almond results in an allergic reaction. This type of allergy has the potential to cause a severe, life-threatening allergic reaction (anaphylaxis), which includes breathing difficulty.
The second type of almond allergy can be considered a secondary food allergy. A person with this type of allergy is initially allergic to birch pollen, an important cause of spring hay fever, and then starts reacting to almond. This happens because of a process called cross-reactivity — where a protein found in birch pollen has similarities with a protein found in almonds and therefore some people react to almond. These reactions are usually mild and include itching or swelling in the mouth. The condition is known as pollen food syndrome (also oral allergy syndrome). People affected may also have mild reactions to hazelnuts, walnuts, certain kinds of pipped fruit (for example, apples) stoned fruits (for example, peaches, cherries) and raw vegetables (for example, carrots and celery).Only a minority of all those people with almond allergy have secondary almond allergy — in other words, most have primary almond allergy.
It is important that you know which of the two types of almond allergy you are affected by. Discuss this with your allergist.
Avoiding other nuts
Some people who are allergic to one type of tree nut may become allergic to others. There is also the possibility of certain nuts coming into contact with others during food production. So is it best to avoid all nuts if you are allergic to one or two of them?
Some allergy experts would indeed advise that total avoidance is best in order to play safe. But others disagree. One study states: “In peanut or tree nut allergic children, introduction of specific nuts to which the child is not allergic may improve quality of life and should be considered in patients with multiple foods allergies, vegan or ethnic-specific diets, in whom nuts are an important source of protein.”
Our advice is that it depends what tests you have had. If you have been tested for specific nuts, your doctor or allergist will be able to advise whether it is possible to include certain nuts in your diet. If you do eat specific nuts, it is usually advisable to do so at home so you can better control any risk of cross-contamination. Eating nuts from the shells avoids the risk of cross-contamination from other nuts.
If you have not been tested for specific nuts, then we believe in playing safe — avoiding all nuts — until you are able to be tested.
Almonds are used in products that such as cakes, bread, biscuits, muesli, confectionery and ice cream. One such cake is Bakewell tart. Almonds are used to make marzipan, frangipane and praline.
In Indian cuisine they are used in a variety of recipes including those for Peshwari naan and many forms of curry. We advise people with severe nut allergy to avoid Asian restaurants (such as Indian, Chinese or Thai) because nuts are so commonly used as ingredients, and there is also a risk of cross-contamination.
Almonds are used to make some liqueurs such as Amaretto. If in doubt about any liqueur contact the manufacturer (or visit their website) to check for almond content.
If you can eat some types of nut but not others, always check to make sure there have been no substitutions. This is particularly important when you eat out because a dish normally made with one nut can be made with another for reasons of cost.
Almond extract: This is made from almonds and so should be avoided by people who are allergic to almonds.
Almond essence: This is a very strong smelling clear liquid, again made from almonds, and so should be avoided by people who are allergic to almonds.
Almond flavouring: Almond flavouring may be made from almonds or it may not be. Because of this uncertainty we believe it is best to be cautious and avoid almond flavourings if you are allergic to almonds.
Oils and other derivatives
Almond oil should be avoided by anyone allergic to almonds.
Almond oil is most commonly used in confectionery and pastries. It may be used for shallow frying fish, especially trout.
It is used in a few pharmaceutical products.
Almond oil and other almond derivatives are used in toiletries such as creams, soaps, shampoos and hair conditioners. When almond ingredients are used in toiletries they are labelled in Latin. You need to watch out for the following words:
Prunus amygdalus amara (bitter almond).
Prunus amygdalus dulcis (sweet almond).
Detailed information on severe allergy (anaphylaxis) and its treatment can be found on “Our Factsheets” webpage.
See Factsheets on Adrenaline and Anaphylaxis – the Facts in the Anaphylaxis: General advice and information section.
See also the Food allergen factsheets section for our factsheet on food allergens found in Cosmetics and other personal care products.
This article has been reviewed by Dr Gary Stiefel, Consultant in Paediatric Allergy, University Hospitals of Leicester NHS Trust; and Dr Richard Pumphrey, Honorary Consultant Immunologist, Central Manchester University Hospitals.
Disclosures: Dr Pumphrey is a medical advisor to MEDA; has received previous financial support from Lincoln Medical to attend a European allergy meeting; has received previous financial support from ALK AbellÃ³ to attend scientific meetings; and is a medical adviser to the Anaphylaxis Campaign. Dr Stiefel has no relevant disclosures.
All the information we produce is evidence based or follows expert opinion and is checked by our expert Clinical and research reviewers. If you wish to know the sources we used in producing any of our information products, please let us know, and we will gladly supply details.
Publication date: June 2015
Review date: June 2018