When using dietary avoidance to treat nut allergies, be sure that the patient can properly identify peanuts and tree nuts. 

In a recent study, persons aged 6 years and older were asked to identify peanuts and nine tree nuts — including almonds, Brazil nuts, cashews, hazelnuts, Macadamia nuts, pecans, pine nuts, pistachios, and walnuts — displayed in 19 different forms. The 649 adults and 459 children who completed the study identified an average of 8.4 nuts (44.2%). Children aged 6 to 18 years were only able to identify a mean 4.6 nuts (24.2%), compared with 11.1 (58.4%) for adults older than age 18 years. 

Half of people with a peanut or tree-nut allergy correctly identified all forms of nuts to which they were allergic, but these respondents performed no better than nonallergic subjects on the test. Furthermore, parents of children with nut allergies did no better than parents of nonallergic children.

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“Overall, both children and adults are unreliable at visually identifying most nuts,” concluded Todd L. Hostetler, MD, and colleagues (Ann Allergy Asthma Immunol. 2012;108:25-29).

The most commonly identified items were peanuts in the shell and out of the shell. Hazelnuts both in the shell and out of the shell were the least commonly identified tree nut.