The only effective prevention of an allergic reaction to tree nuts is the complete avoidance of tree nuts and tree nut products. This means constant vigilance when buying food in a grocery store, eating at a friend’s house or eating out at a restaurant. Individuals with tree nut allergies must always check the labels of the foods they purchase and inquire about food preparation and ingredients when they are eating away from home. Accidental exposure to tree nut proteins can be fatal.

Because eating just a trace amount of tree nut protein can trigger an allergic response, allergic individuals must be very careful of what types of foods they consume. Many types of foods contain tree nuts. Allergic individuals should educate themselves on some of the other names of products that may contain tree nuts. For example, gianduja is hazelnut-flavored chocolate and caponata is an eggplant-based relish that may contain pine nuts.

New food labeling laws which took effect in January 2006 may make it easier for people to determine if a food item contains any tree nuts or tree nut products (e.g., tree nut oil). If tree nuts are used to make a packaged product, the manufacturer must clearly list the specific type of tree nut it contains.

People need to be careful of not only ingredients, but food preparation methods as well. Kitchen utensils or factory equipment that come into contact with tree nuts can accidentally spread tree nut molecules into other foods when not properly cleaned between uses. Manufacturers may disclose on package labels whether products have been processed on equipment also used to prepare tree nut products. Many manufacturers offer toll-free customer service lines to answer questions regarding their products. Commonly printed on product packaging, these phone numbers enable individuals to inquire about ingredients as well as other concerns.  

Tips to avoid exposure to tree nuts while dining out include:

• Keep restaurant orders simple. Baked and broiled items and single food items are better choices than items with many ingredients. For example, a baked potato is a better choice than potato souffle, which may contain unknown ingredients.
  
  
• Avoid creams, dressings, sauces and toppings.
  
  
• Avoid salad bars and buffet lines. Serving utensils are often used interchangeably in these serving situations.
  
  
• Avoid ethnic foods that usually contain tree nuts (e.g., African, Asian).
  
  
• Take special note when ordering dessert. Nuts may be used, even if not indicated on the menu.
  
  
• Avoid asking the waiter or waitress about the ingredients used in the dishes. Only the owner or the person overseeing the kitchen should be approached.

Epinephrine is a synthetic form of adrenaline that, when injected, works as a powerful bronchodilator, reversing the symptoms of anaphylactic shock. It opens breathing tubes and restores normal respiration quickly. It also raises blood pressure. A physician may recommend that patients carry an injection of epinephrine with them at all times and understand how to self-administer the drug. A medical alert bracelet or necklace may also be recommended.

In the case of children with tree nut allergies, schools, daycare facilities and clubs all need to be informed of the child’s condition. Schools should work closely with the parents to make sure the child does not accidentally come into contact with tree nuts in the cafeteria or the classroom. Babysitters, grandparents, and the parents of friends should all be advised of the child's allergy and should be taught emergency treatment procedures.

Activated charcoal may help reduce the severity and progression of an allergic reaction to tree nuts. The therapy works by binding to the major allergens in the nut, blocking the allergens from interacting with the immune system and preventing allergy symptoms. This type of therapy may not be suitable for treating a tree nut allergic reaction by itself. It should be used only after another type of more effective treatment (e.g., epinephrine) has been administered.

In some cases, antihistamines and other allergy medications may also be used to treat less severe symptoms of allergic reactions.