The prevalence of peanut allergies among children in Western countries, including the UK, has doubled in the past decade. In 2024, the prevalence of nut allergies in the UK is estimated as follows: 

 

1. Peanut Allergy: The cumulative prevalence is about 0.7 - 1.4% of the population. 

2. Tree Nut Allergy: The prevalence of confirmed tree nut allergy is under 2%. It's important to note that these figures include both peanut and tree nut allergies, and there can be overlap where individuals are allergic to both. Peanut allergies are somewhat more common than tree nut allergies, and there's a notable risk of co-allergy among individuals with either allergy. 

 

Those with a peanut allergy have a 25–40% risk of developing a co-allergy to tree nuts. In terms of tree nut allergies, challenge-confirmed cases are under 2%, with hazelnut being the most common tree nut allergy in Europe. In the UK, other nuts such as almond, walnut, and Brazil nut might be more relevant. It's also highlighted that while peanut and tree nut allergies are often considered lifelong, up to 40% of those with a peanut allergy might experience resolution. Additionally, 30-40% of individuals with a peanut allergy will tolerate some tree nuts. These allergies usually occur in pre-school children but can also develop in adults. The allergies are characterized by IgE mediated reactions to nut proteins, and primary nut allergy typically presents in the first five years of life, often after the first known ingestion. These allergies pose a significant risk, as more than half of anaphylaxis fatalities occur when eating restaurant or takeaway food. For this reason, individuals with peanut and/or tree nut allergies are often prescribed adrenaline (epinephrine) for emergency situations. 

If peanut allergy or tree nut allergy is confirmed, you may be prescribed adrenaline auto-injectors (AAIs) for use in an emergency. The UK’s Medicines and Health care Products Regulatory Agency (MHRA) and the National Institute for Health and Care Excellence (NICE) recommend that medical professionals prescribe two AAIs, which patients should carry at all times in case one is broken or misfires or a second injection is needed before emergency help arrives. 

 

After an adrenaline injection has been given, someone must dial 999 immediately, as symptoms may return after a short period and more than one injection may be required. The emergency service operator must be told the person is suffering from anaphylaxis (pronounced ana-fill-axis). 

 

The adrenaline auto-injectors available in the UK are EpiPen, Jext and Emerade. If you are prescribed AAIs, you will need to know how to use them and regular training in their use is essential. Correct usage of an injector will significantly reduce the risk of an allergic reaction progressing. Ask your GP or allergist for advice. 

A recent review of fatal food anaphylaxis data in the UK found that peanut and tree nut allergies are the most common known food triggers, however, the proportion of deaths due to peanut and tree nut allergies from 1998 to 2018 has decreased in the UK. 

 

The age of the person with the allergy could be a risk factor. One study found fatal reactions to food are more likely to occur between the ages of 17-27. As young people begin to manage their allergies for themselves, they may be less cautious with regard to risk, reluctant to ask direct questions in restaurants and subject to peer pressure. 

 

Once you have a confirmed peanut or tree nut allergy diagnosis, it is important to exclude your allergen from your diet. Read food labels carefully and question staff in restaurants, takeaways and other catering establishments. 

 

In 2024, the risks of nut allergies primarily include severe allergic reactions like anaphylaxis, which can be life-threatening. Management involves strict avoidance of nuts, carrying adrenaline auto-injectors for emergency use, and having an emergency action plan. Diagnostic tests such as allergen-specific IgE tests and skin prick tests help in confirming the allergy. Regular consultation with healthcare providers, especially for children and individuals with multiple allergies or asthma, is crucial. Additionally, there's emerging advice on the early introduction of peanuts in infancy to potentially prevent peanut allergies. For more comprehensive management strategies, resources from organizations like the British Dietetic Association and Allergy UK, British Society for Allergy and Clinical Immunology, Anaphylaxis Campaign, and the Royal College of Paediatrics and Child Health provide resources and advice for managing nut allergies are recommended. 

Some people with a peanut allergy may be allergic to tree nuts, and some people allergic to one tree nut may be allergic to others.  

 

Research suggests a significant number of people with a cashew nut allergy are also allergic to pistachios. 

 

There is a similar link between walnut and pecan nuts. 

 

There is also the possibility of certain nuts coming into contact with others during food production. 

 

Eating nuts from the shells helps reduce the risk of cross-contamination from other nuts. 

 

If you have an allergy to peanuts or to one type of tree nut, it is important to have allergy testing for other nuts so your allergy specialist can advise on including them in your diet. Research suggests it is important to include nuts you are not allergic to in your diet, as this helps to maintain tolerance and avoid developing an allergy to those nuts in the future. Introduction of other nuts must only be done as advised by your allergy specialist, after allergy testing. 

 

Legumes: Peanuts are actually legumes. A small number of people with a peanut allergy may react to other legumes (such as soya, peas, chickpeas, fenugreek, beans and lentils). One research study found 5% of children with a legume allergy reacted to more than one legume. 

 

Lupin: Lupin is a legume. Studies have shown that some people with a peanut allergy react to lupin. 

 

Sesame seeds: A US study found children with a history of reactions to both peanuts and tree nuts were more likely to have allergic reactions to sesame. A recent European study also found a link between peanut, tree nut and sesame seed allergies. 

 

Other foods: People with nut allergies frequently ask if they should avoid certain foods with “nut” in the name – even those that are botanically different to tree nuts. These include pine nuts, coconut, nutmeg and chestnut. If you are allergic to nuts and have never had a reaction to any of these foods, it is likely that they are safe for you to eat. 

 

Your allergy specialist will be able to give you specific advice regarding which foods you should avoid.