Essential lessons for nut allergies: The hidden hiding places of cashews, walnuts, and almonds

Cashews, walnuts, and almonds, the three most common allergenic nuts, are hidden far beyond the obvious categories such as nut snacks and baked pastries. There may be trace residues in processed meat products, compound seasonings, daily care products, and even some medicines. People with severe allergies may trigger anaphylactic shock even if they are exposed to dozens of micrograms. Identifying these hidden sources in advance is the first priority for people with nut allergies.

Last year, I accompanied a friend with a nut allergy to the allergist department for a follow-up visit. I happened to meet a 16-year-old girl who ate two bites of the Yangzhou Lion Head ordered from takeout. She was out of breath as soon as she walked out of the store and was taken to the emergency room. Her mother was confused as she stood at the triage table and repeatedly said, "Why are there nuts in the Lion Head?" Later, I checked the restaurant's internal recipe and found out that their lion's head is made with 10% roasted walnuts to add flavor, and it is stewed so soft that there is no graininess at all. Before, the girl only knew to avoid nut milk and almond cookies, and did not think about home-cooked food at all.

Don't think this is a low-probability event. Many people like to make hot pot salad dressing. Most of the industrially produced versions add chopped almonds or cashew nuts to enhance the freshness. Some salad dressings are even labeled as "vegan and no additives." In order to create a creamy and non-greasy texture, raw cashew nuts are used as the base, and even the nut residue is filtered out. You can't taste anything unusual when you eat it. If the ingredient list is vague, you can't find it at all. Oh, by the way, there are also "additive-free rice cakes" and "cereal puffs" that many parents love to buy for their children. If the production line processes foods containing nuts at the same time, even if there are no nuts in the ingredients, there may be cross-contamination residues. Last year, a mother came to me for consultation and said that her child had a rash on her face after eating a certain Internet celebrity baby rice cake. Later, she asked the brand for an internal test report and found that there was a trace amount of walnut protein residue in it, which was caused by the production line not being cleaned when changing products.

There are actually two different opinions in the industry regarding the avoidance standards for nut allergies, and there is no absolute right or wrong. One group is the absolute zero-contact group, advocating that as long as the ingredient list has warnings of "may contain nuts" and "nuts are processed on the production line at the same time," you must not touch it. After all, the threshold for severe allergies is as low as the microgram level, and even a small amount may be fatal. ； The other school is the individualized threshold school. They believe that as long as they have done an oral provocation test under the guidance of a doctor and clarified the tolerance level, for example, if they can accept less than 10 mg of nut protein, they can also try small amounts of foods with cross-contamination warnings without excessive anxiety. Both of these statements are supported by clinical data. The specific choice depends mainly on the degree of allergies of the individual - if you have had a history of laryngeal edema or anaphylactic shock before, you are right to listen to the first school. ； If you only have a mild rash or itchy skin, you can also ask a doctor to test the threshold, which will help you reduce unnecessary restrictions in your life.

Do you think everything will be fine once you avoid the entrance? Not really. Nut ingredients in many daily cosmetics are often avoided by people with allergies. A while ago, a patient told me that she bought a very popular fruit acid body scrub, and after using it twice, she developed hives all over her arms and legs. It took her a long time to find the cause, but she discovered that the scrub particles were powdered from walnut shells. She had not paid attention to the ingredients of the product before. There are also many lip balms and hand creams that add sweet almond oil and cashew oil as moisturizing ingredients. People with sensitive lips or skin may experience itching or swelling like a sausage mouth if they use it, which is hard to prevent. Oh, yes, there are also many people who think that medicines that are completely unrelated to each other may be misleading. For example, many Chinese patent medicines for coughs contain bitter almonds as active ingredients, and some honey pills also use nut-derived starch as excipients. When taking medicine, it is best to tell the pharmacist in advance that you have a nut allergy and ask for help to check.

My usual advice to allergy sufferers is not to just scan the ingredient list when buying something to see if there are words like "cashew nuts, walnuts, almonds". You should also pay attention to vague expressions like "nut products, vegetable protein, almond extract, shell powder, nut butter", especially for imported foods. Sometimes the translated ingredient list will miss the label, so it is best to check the original ingredient list. Don’t be embarrassed to ask when ordering takeout or eating out, such as whether there are nuts in the salad dressing and whether there are chopped nuts in the meatballs. It’s just a question. It’s really better than going to the hospital afterwards.

Oh, by the way, I couldn't help but say something in the end, I really accidentally came into contact with the allergen, don't bear it, the epinephrine pen you brought with you immediately pricked the outside of the thigh, and went to the hospital immediately after pricking, it is more effective than taking any anti-allergy medicine. Nut allergy is a troublesome thing, but it is also simple. It is always right to pay more attention.