What is a level 6 nut allergy

What is an allergy blood test?

Allergies are a common and chronic condition that involves the body’s immune system. Normally, your immune system works to fight off viruses, bacteria, and other infectious agents. When you own an allergy, your immune system treats a harmless substance, love dust or pollen, as a threat. To fight this perceived threat, your immune system makes antibodies called immunoglobulin E (IgE).

Substances that cause an allergic reaction are called allergens. Besides dust and pollen, other common allergens include animal dander, foods, including nuts and shellfish, and certain medicines, such as penicillin.

Allergy symptoms can range from sneezing and a stuffy nose to a life-threatening complication called anaphylactic shock. Allergy blood tests measure the quantity of IgE antibodies in the blood. A little quantity of IgE antibodies is normal. A larger quantity of IgE may mean you own an allergy.

Other names: IgE allergy test, Quantitative IgE, Immunoglobulin E, Entire IgE, Specific IgE


Authors and Reviewers

Originally written in by:
Jane Higdon, Ph.D.
Linus Pauling Institute
Oregon State University

Updated in December by:
Jane Higdon, Ph.D.
Linus Pauling Institute
Oregon State University

Updated in March by:
Barbara Delage, Ph.D.
Linus Pauling Institute
Oregon State University

Reviewed in September by:
Emilio Ros, M.D., Ph.D.
Former Director
Lipid Clinic, Endocrinology & Nutrition Service, Hospital Clínic
University of Barcelona
Barcelona, Spain

Copyright   Linus Pauling Institute 

What Are Peanut and Tree Nut Allergies?

Peanuts are among the most common allergy-causing foods, and they often discover their way into things you wouldn’t expect.

Take chili, for example: It may be thickened with ground peanuts.

Peanuts aren’t actually a true nut; they’re a legume (in the same family as peas and lentils). But the proteins in peanuts are similar in structure to those in tree nuts. For this reason, people who are allergic to peanuts can also be allergic to tree nuts, such as almonds, Brazil nuts, walnuts, hazelnuts, macadamia nuts, pistachios, pecans, and cashews.

Sometimes people outgrow some food allergies over time (like milk, egg, soy, and wheat allergies), but peanut and tree nut allergies are lifelong in numerous people.

What Happens With a Tree Nut or Peanut Allergy?

When someone has a nut allergy, the body’s immune system, which normally fights infections, overreacts to proteins in the nut.

If the person eats something that contains the nut, the body thinks these proteins are harmful invaders and responds by working extremely hard to fight off the invader. This causes an allergic reaction.

Even a little quantity of peanut or tree nut protein can set off a reaction. But allergic reactions from breathing in little particles of nuts or peanuts are rare. That’s because the food generally needs to be eaten to cause a reaction. Most foods with peanuts in them don’t permit enough of the protein to escape into the air to cause a reaction. And just the smell of foods containing peanuts won’t cause one because the scent doesn’t contain the protein.


Cardiovascular disease

In large prospective cohort studies, regular nut consumption has been consistently associated with significant reductions in the risk of coronary heart disease (CHD).

An early study that followed more than 30, Seventh Day Adventists over 12 years found that participants who consumed nuts at least five times weekly had a 48% lower risk of death from CHD and a 51% lower risk of nonfatal myocardial infarction (MI) compared to those who consumed nuts less than once weekly (1). In addition, the risk of death from CHD was 39% lower in Seventh Day Adventists older than 83 years who ate nuts at least five times weekly compared to those who consumed nuts less than once weekly (2). More recently, an analysis of data from the Nurses’ Health Study I that followed 84, women (ages at enrollment, years) for 26 years reported a 32% lower risk of CHD in those who ate an average of servings/week compared to those who never ate nuts (3).

A meta-analysis of 13 prospective cohort studies, including the Seventh Day Adventists and Nurses’ Health Studies, found a 34% lower risk of CHD with the highest versus lowest level of nut consumption (4). A dose-response analysis indicated that every 1 serving/week increment in nut consumption was associated with a 5% reduction in CHD risk (4). In another meta-analysis that included data from over , participants enrolled in three large cohort studies, weekly intake of at least five servings of nuts was associated with a 20% lower risk of CHD when compared to no consumption (5).

However, there was no evidence of an association between nut consumption and risk of stroke. In contrast, another recent meta-analysis of prospective cohort studies found a 12% lower risk of stroke (14 studies) and a 19% lower risk of stroke-related death (seven studies) with the highest versus lowest intake of nuts (6).

The PREDIMED (Prevención con Dieta Mediterránea) study that took put between was a multicenter, randomized controlled trial that examined the effect of a Mediterranean diet, with either extra-virgin olive oil or nuts, compared to a control diet, in the primary prevention of cardiovascular events in 7, adults (≥55 years) at high risk of cardiovascular disease(7).

Adherence to a Mediterranean diet, supplemented with olive oil or mixed nuts for almost five years resulted in a 30% lower risk of cardiovascular events and no weight acquire (7).

Finally, a modeling study estimated that an increase in daily nut intake from 5 g to 30 g could own prevented 7, incidental cardiovascular events and saved about 65, years of life that were lost to stroke or heart attack in a scenario based on data from the Swedish population in (8).

Cardioprotective compounds in nuts

Nuts are energy-dense in specific because of their high fat content; yet, most of their fat is in the form of monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs).

MUFAs and PUFAs are fatty acids that respectively contain one or more carbon-carbon double bonds (C=C) in their chemical structure, as opposed to saturated fatty acids that own none. Tree nuts contain more MUFAs than PUFAs with the exception of walnuts and pine nuts, which own more PUFAs than MUFAs, and Brazil nuts, which contain equivalent amounts of MUFAs and PUFAs (Table 1). Walnuts are especially wealthy in α-linolenic acid (~ g/ounce), an omega-3 fatty acid with cardioprotective properties (see the article on Essential Fatty Acids). Other bioactive compounds, including micronutrients, phytosterols, and fiber, may also contribute to improving the cardiometabolic profile (Table 1 and Figure 1).

Some nuts (pecans, pistachios, almonds, and hazelnuts) are a source of flavonoids that may contribute to cardiovascular health (see the article on Flavonoids) (23). For more information on the nutrient content of nuts, search the USDA Food Composition Database.

Nut (1 ouncea) Energy (kcal) Protein (g) Total fat (g) MUFAb (g) PUFAc (g) Phytosterols (mg) Fiber (g)



Brazil nuts






Macadamia nuts



Peanut butter, smoothd (2 tbsp)



Pine nuts (pignoli)




Walnuts, Black


The US Food and Drug istration (FDA) has acknowledged the current evidence for a relationship between nut consumption and cardiovascular disease by approving the following qualified health claim for nuts (24): «Scientific evidence suggests but does not prove that eating ounces per day of most nuts (such as macadamia nuts (25)) as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease» (24).

[Figure 1 — Click to Enlarge]

Weight control

A frequent concern is that increased consumption of nuts, which are high in fatty acids and energy thick, may cause weight acquire and obesity.

A data analysis of NHANES found that tree-nut consumers (≥¼ ounce/day) had significantly lower BMI and waist circumference than non-consumers (<¼ ounce/day) and were 23% less likely of becoming overweight or obese (9). In addition, in the European Prospective Investigation into Cancer and Nutrition study (EPIC-PANACEA) that followed , adults (ages, years), weight acquire over a five-year period was significantly lower ( kg) in those in the highest quartile of nut intake (median, g/day) compared to non-consumers (30). Moreover, the risk of becoming overweight or obese was also 5% lower in those in the highest quartile of nut intake compared to non-consumers (30). A meta-analysis of little randomized controlled trials found that changes in measures of body weight (28 trials, 1, participants), BMI (14 trials, 1, participants), or waist circumference (5 trials, participants) were similar when nut-rich diets were compared to standard diets (31).

There was some feeble evidence suggesting modest reductions in body weight, BMI, and waist circumference measures with nut-rich diets (compared to standard diets) in energy-restriction rather than weight-maintenance interventions (31).

Current epidemiological data indicate that higher nut consumption does not result in greater weight gain; rather, incorporating nuts into diets may be beneficial for weight control.

Finally, it has been suggested that higher amounts of protein and fiber in nuts could enhance satiety and suppress hunger (32). In a recent randomized controlled trial in overweight or obese participants, weight loss and improvements in blood lipid profile and blood pressure over a six-month period were found to be similar regardless of whether walnuts were supplemented to a reduced-energy density diet (33).

In addition, there was no difference in reports of satiety between groups (33).


Only a few observational studies own examined nut intake in relation to cancer risk. In the Netherlands Cohort Study that followed , adults (ages, years) for about 20 years, there was no association between tree nut, peanut, peanut butter, and entire nut consumption and the risk of pancreaticcancer(34). Another analysis of data from 62, women in this cohort showed that the highest versus lowest quartile of entire nut intake (≥10 g/day versus 0 g/day) was associated with a 45% reduced risk of certain breast cancer subtypes, namely ER- and ER-/PR- (estrogen receptor-negative/progesterone receptor-negative) breast cancers (35).

Nut intakes were not associated with other breast cancer subtypes or entire breast cancer (35). In a recent analysis of the NIH-AARP Diet and Health Study that followed , men and women (ages, years) for a median years, the highest versus lowest quartile (median, g/1, kcal versus 0 g/1, kcal) of entire nut intakes (walnuts, peanuts, seeds, and other nuts) was associated with a 27% lower risk of gastric noncardia adenocarcinoma (36). There were no associations between entire nut intake and risk of gastric cardia adenocarcinoma, esophageal adenocarcinoma, or esophageal squamous cell carcinoma (36).

Although nuts contain numerous anti-carcinogenic compounds, including some vitamins, minerals, unsaturated fatty acids, phytosterols, and fiber, there is extremely little evidence that nut consumption might protect against cancer.

Adverse effects

Brazil nuts grown in areas of Brazil with selenium-rich soil may provide more than µg of selenium in one nut, while those grown in selenium-poor soil may provide 10 times less (56). For information regarding toxicity of selenium, see the article on Selenium.

Living With Peanut or Tree Nut Allergy

If allergy skin testing shows that your kid has a peanut or tree nut allergy, an will provide guidelines on what to do.

The best way to prevent a reaction is to avoid peanuts and tree nuts.

Avoiding these nuts means more than just not eating them. It also means not eating any foods that might contain tree nuts or peanuts as ingredients.

The best way to be certain a food is nut-free is to read the food label. Manufacturers of foods sold in the United States must state on their labels whether the foods contain peanuts or tree nuts. Check the ingredients list first.

After checking the ingredients list, glance on the label for phrases love these:

  1. "may contain tree nuts"
  2. "produced on shared equipment with tree nuts or peanuts"

Although these foods might not use nut ingredients, the warnings are there to let people know they might contain traces of nuts.

That can happen through "cross-contamination," when nuts get into a food product because it is made or served in a put that uses nuts in other foods. Manufacturers are not required to list peanuts or tree nuts on the label when there might be accidental cross-contamination, but numerous do.

Some of the highest-risk foods for people with peanut or tree nut allergy include:

  1. Asian, African, and other cuisine. African and Asian (especially Thai, Chinese, and Indian) foods often contain peanuts or tree nuts.

    Mexican and Mediterranean foods may also use nuts, so the risk of cross-contamination is high with these foods.

  2. Cookies and baked goods. Even if baked goods don’t contain nut ingredients, they might own come in contact with peanut or tree nuts through cross-contamination. Unless you know exactly what went into a food and where it was made, it’s safest to avoid store-bought or bakery cookies and other baked goods.
  3. Ice cream. Unfortunately, cross-contamination is common in ice cream parlors because of shared scoops.

    It’s also a possibility in soft-serve ice cream, custard, water ice, and yogurt shops because the same dispensing machines and utensils are often used for lots of diverse flavors. Instead, do as you would for candy: Purchase tubs of ice cream at the supermarket and be certain they’re made by a large manufacturer and the labels indicate they’re safe.

  4. Candy. Candies made by little bakeries or manufacturers (or homemade candies) may contain nuts as a hidden ingredient. The safest plan is to eat only candies made by major manufacturers whose labels show they are safe.
  5. Sauces. Numerous cooks use peanuts or peanut butter to thicken chili and other sauces.

Always be cautious.

Even if your kid has eaten a food in the past, manufacturers sometimes change their processes — for example, switching suppliers to a company that uses shared equipment with nuts. And two foods that seem the same might own differences in their manufacturing. Because ingredients can change, it’s significant to read the label every time, even if the food was safe in the past.

How Is an Allergic Reaction Treated?

A nut allergy sometimes can cause a severe reaction called anaphylaxis.

Anaphylaxis might start with some of the same symptoms as a less severe reaction, but can quickly get worse. The person may own trouble breathing or pass out. More than one part of the body might be involved. If it isn’t treated, anaphylaxis can be life-threatening.

If your kid has a peanut or tree nut allergy (or any helpful of serious food allergy), the doctor will desire him or her to carry an epinephrine auto-injector in case of an emergency.

An epinephrine auto-injector is a prescription medicine that comes in a little, easy-to-carry container. It’s simple to use. Your doctor will show you how. Kids who are ancient enough can be taught how to give themselves the injection.

If they carry the epinephrine, it should be nearby, not left in a locker or in the nurse’s office.

Wherever your kid is, caregivers should always know where the epinephrine is, own simple access to it, and know how to give the shot. Staff at your child’s school should know about the allergy and own an action plan in put. Your child’s medicines should be accessible at every times.

Every second counts in an allergic reaction. If your kid starts having serious allergic symptoms, love swelling of the mouth or throat or difficulty breathing, give the epinephrine auto-injector correct away.

Also give it correct away if the symptoms involve two diverse parts of the body, love hives with vomiting. Then call and take your kid to the emergency room. Your kid needs to be under medical supervision because even if the worst seems to own passed, a second wave of serious symptoms can happen.

Disease Prevention

Cognitive function

An analysis of NHANES data from the and surveys suggested higher scores on cognitive tests in participants (ages ≥20 years) with regular intakes of walnuts (>10 g/day) compared to non-consumers (37).

In the Nurses’ Health Study I, which included 19, women ≥70 years of age, the highest quintile of long-term nut intake (≥5 servings/week) was associated with higher scores on global cognition and verbal memory tests compared to the lowest quintile of intake (<1 serving/month) (38). However, entire nut intake in this study was not linked to rate of cognitive decline among individuals over a six year-period (38). Results from the PREDIMED study in participants (mean age, years) at high vascular risk showed higher global cognition test scores in those assigned to a Mediterranean diet supplemented with either extra-virgin olive oil or mixed nuts compared to those fed a control diet for years (39).

Although participants in each intervention group were unlikely to be cognitively diverse as a result of randomization at the start of the study, baseline cognitive status was not assessed and thus the conclusions of this study are limited (39). A follow-up PREDIMED study in older adults (mean age, years) whose cognitive functions own been assessed both at enrollment and at study completion showed little-to-no evidence of differences in changes in individual test scores over four years between intervention groups and the control group (40). However, when composite test scores were considered to better describe cognitive functions, the result showed that the consumption of a diet supplemented with either extra-virgin olive oil or mixed nuts prevented the decline of global cognitive function, as well as verbal and episodic memory and frontal cognitive functions (attention, cognitive flexibility, and working memory), which was reported in the subjects randomized to the control diet.

Type 2 diabetes mellitus

Early results from the Nurses’ Health Study I suggested that nut and peanut butter consumption might be inversely associated with the risk of type 2 diabetes mellitus in women (26).

However, two independent meta-analyses of more recent prospective cohort reported no evidence of an association between nut consumption and risk of type 2 diabetes (27, 28).

Nonetheless, a meta-analysis of 12 randomized controlled trials in participants with type 2 diabetes showed that supplementation with tree nuts for a median of eight weeks could reduce fasting glucose concentration and glycated hemoglobin (HbA1c) concentration, a measure of glycemic control (29). Although there were no significant effects on fasting insulin concentration or a measure of insulin resistance (HOMA-IR) (29), these findings propose that nuts might be part of a healthful diet for the management of hyperglycemia in individuals with type 2 diabetes.

Nut allergies

Peanuts and tree nuts are among the most common foods to trigger allergic reactions, potentially severe (anaphylaxis) and fatal (48).

What is a level 6 nut allergy

Such reactions can be triggered by a primary antibody response against some nut proteins or by antibodies raised against protein in pollen but cross-reacting with structurally similar proteins in nuts. Mixed method-based estimates of peanut allergy in US children propose that the condition is increasingly prevalent and ranges between 2 and 5% (49). Estimates based solely on self reports propose a prevalence of tree nut allergy <1% in US adults and <2% in US children (50). Individuals with peanut or tree nut allergies need to take special precautions to avoid inadvertently consuming peanuts or tree nuts by checking labels and avoiding unlabeled snacks, candies, and desserts (50).

See the Food Allergy Research and Education website for additional tips to avoiding unintentional peanut or tree nut exposure.

Nut consumption during pregnancy and lactation

In the ‘Guidelines for the Diagnosis and Management of Food Allergy in the United States,’ the National Institute of Allergy and Infectious Diseases discourages nut avoidance during pregnancy or breastfeeding as a way of preventing food intolerance in the offspring (51). Results from two birth cohort studies suggested an inverse association between maternal peanut or tree nut consumption during, shortly before, or just after their pregnancy and the risk of food allergy (including nut allergy) in the offspring (52, 53), supporting the current recommendations.

Yet, prior studies found higher peanut consumption in mothers of children with peanut allergy (54). Additional studies are needed to clarify the effect of maternal nut intake on food tolerance in the offspring.

Risk factors

Blood lipids: In a cross-sectional analysis of a representative sample of the US population — the National Health and Nutrition Examination Survey [NHANES] — tree nut consumers (≥¼ ounce/day) were found to own higher blood HDL-cholesterol concentrations and lower body mass index (BMI), waist circumference, and systolic blood pressure than subjects consuming <¼ ounce/day (9).

However, these observations may be due to reverse causation, in specific because health-conscious people are more likely to consume healthy diets that include nuts. A meta-analysis assessed the evidence of the effect of tree nut consumption on blood lipid profile using findings from 42 randomized controlled studies in a entire of 2, participants, among which 45% were at risk of cardiovascular disease and untreated. Results indicated lower concentrations of entire and LDL-cholesterol concentrations but no effect on concentrations of HDL-cholesterol or triglycerides(10).

Similar observations were made in meta-analyses of interventions examining the specific effect of walnut (11, 12), almond (13), hazelnut (14), or pistachio (15) consumption on blood lipid profile of people with normal or elevated blood cholesterol. Interestingly, in a little recent trial in 46 statin-treated participants, the daily consumption of g (~ ounces) of almonds for four weeks led to a % reduction in non-HDL-cholesterol (i.e., entire cholesterol minus HDL-cholesterol) concentration (16).

Blood pressure: Adherence to a Mediterranean diet for almost four years in the PREDIMED trial led to significant improvements in diastolic (but not systolic) blood pressure compared to a control diet.

However, there were no differences in blood pressure changes whether the Mediterranean diet was supplemented with nuts or olive oil (17). A meta-analysis of 21 randomized controlled trials in 1, participants found little evidence for an effect of nut supplementation on either systolic or diastolic blood pressure. A blood pressure-lowering effect of nuts was reported when only subjects without type 2 diabetes mellitus were considered. Of note, this meta-analysis included four trials that used either peanuts or soy nuts, which are not tree nuts (18).

Endothelial function: Measures of brachial flow-mediated dilation (FMD), a surrogate marker of endothelial function, are inversely associated with risk of cardiovascular events.

A meta-analysis of eight randomized controlled trials suggested that supplementation with walnuts (four studies), pistachios (three studies), or almonds (one study) for up to 12 weeks may assist increase FMD in subjects at risk of cardiovascular disease(19). Similar observations were reported in another recent meta-analysis of randomized controlled trials (20).

Chronic low inflammation: A meta-analysis of 20 little randomized controlled trials conducted primarily in subjects at high risk for cardiovascular disease found no evidence of an effect of nut supplementation for up to 12 weeks (only two studies lasted longer) on markers of inflammation in blood (21).

Of note, four of the trials included in this meta-analysis exclusively supplemented participants with either peanuts or soy nuts. Nonetheless, a similar conclusion was reached in another meta-analysis of 25 interventions (19).

Of note, a recent systematic review of meta-analysis corroborated the account of the cardiovascular health benefits of nut consumption presented above (22).

Introduction to peanuts during infancy

A addendum to the ‘Guidelines for the Diagnosis and Management of Food Allergy in the United States’ included recommendations for the prevention of peanut allergy through the early introduction of peanuts in infants’ diet (55) (Table 2).

Infant Criteria Earliest Age for Peanut Introduction Recommendations
Severe eczema and/or egg allergy  months
  1. Peanut introduction should start after the introduction of solid foods without peanuts.
  2. Peanut introduction only after measurement of peanut-specific antibodies and/or skin prick testing are found negative.
  3. Infant may still benefit from early peanut introduction even if the month window is missed.
Mild-to-moderate eczema ~6 months
  1. Introduce peanut-containing foods.
No eczema or food allergies Age-appropriate and in accordance with family preferences
  1. Introduce peanut-containing foods.


A meta-analysis of 15 prospective cohort studies, including , participants, found a 19% lower mortality risk with the highest versus lowest levels of entire nut intake (41).

Intakes of tree nuts (four studies), peanuts (five studies), and peanut butter (two studies), separately, were also inversely associated with mortality. In addition, there was a non-linear dose-response relationship between entire nut intake and mortality, suggesting a greater benefit of increasing intakes when intakes are initially low and no additional protection with intakes beyond 15 to 20 g/day. Higher intakes of entire nuts were also found to be inversely associated with mortality related to respiratory disease (three studies) and diabetes mellitus (four studies) (41). These results corroborated findings from other recent meta-analyses (27, 42, 43).

It has been hypothesized that nut consumption could reduce the risk of disease and prolong life through influencing the length of telomeres that protect the ends of chromosomes.

Bioactive compounds in nuts might regulate oxidative stress and inflammation, which are significant drivers of telomere shortening, a marker of biological aging. A few cross-sectional studies own examined the associations between nut consumption and leukocyte telomere length, yet the findings own been rather inconsistent ().


  1. Meta-analyses of prospective cohort studies show that nut consumption is associated with a reduced risk of all-cause mortality and mortality due to chronic conditions. (More information)
  2. Results from large prospective cohort studies show an association between regular nut consumption (≥5 ounces/week) and lower risk of coronary heart disease.

    There is strong evidence from randomized controlled trials that nut consumption lowers blood cholesterol concentrations. (More information)

  3. Peanuts and tree nuts can cause life-threatening allergy reactions. Current guidelines for the primary prevention of allergy set by the National Institute of Allergy and Infectious Diseases discourage nut avoidance by non-allergic women during pregnancy and urge the early introduction to peanuts in age-appropriate foods in infants with no peanut allergy. (More information)
  4. Current epidemiological data indicate that higher nut consumption does not result in greater weight gain; rather, incorporating nuts into the diet may benefit weight control and contribute to reductions in body weight and waist circumference in energy-restriction diets (i.e., weight-loss diets).

    (More information)

  5. Nuts are excellent sources of several micronutrients, as well as unsaturated fatty acids, protein, fiber, and phytochemicals. (More information)
  6. There is little evidence to support an association between regular nut consumption and a lower risk of developing type 2 diabetes mellitus. However, there is some evidence suggesting that nut consumption can improve glycemic control in individuals with type 2 diabetes mellitus. (More information)
  7. Substituting nuts for unhealthy snacks is a excellent strategy to avoid weight acquire and improve the nutritional quality of one’s diet.

    (More information)

What Are the Signs & Symptoms of a Nut Allergy?

When someone with a peanut or tree nut allergy has something with nuts in it, the body releases chemicals love .

This can cause symptoms such as:

  1. hives
  2. sneezing
  3. a drop in blood pressure
  4. swelling
  5. trouble breathing
  6. itchy, watery, or swollen eyes
  7. stomachache
  8. coughing
  9. diarrhea
  10. hoarseness
  11. wheezing
  12. throat tightness
  13. dizziness or fainting
  14. vomiting
  15. anxiety or a feeling something bad is happening

Reactions to foods, love peanuts and tree nuts, can be diverse.

It every depends on the person — and sometimes the same person can react differently at diverse times.

Intake Recommendations

Regular nut consumption, equivalent to 1 ounce of nuts five times weekly, has been consistently associated with significant reductions in risk of coronary heart disease in epidemiological studies. Consuming nuts daily as part of a diet that is low in saturated fat has been found to lower serum entire and LDL-cholesterol in a number of controlled clinical trials. Since an ounce of most nuts provides at least calories (kcal), simply adding an ounce of nuts daily to one’s habitual diet without eliminating other foods may result in weight acquire.

What is a level 6 nut allergy

Substituting unsalted nuts for less healthy snacks or for meat in main dishes are two ways to make nuts part of a healthful diet. A modeling study that used NHANES data from 17, individuals (≥1 year old) estimated that substituting tree nuts for between-meal snacks on a calorie-per-calorie basis would improve the nutritional quality of dietary intakes through a shift in fatty acid intake (less saturated and more unsaturated fatty acids), a reduction in added sugar and sodium (salt), and an increase in potassium, magnesium, and fiber(57).

The Dietary Guidelines for Americans urge the consumption of nuts, seeds, and soy products as part of a healthy diet. The recommendations are presented in Table 3.

Life Stage Age Mediterranean-style or US-style Eating Patternsc Vegetarian Eating Patternd
Children years
Children years
Children years
Adolescents years
Adults 19 years and older

aDietary guidelines apply when no quantitative Dietary Reference Intake (DRI) worth is available.
bThe recommendations in ounce-equivalent (oz-eq) per week are based on estimated energy needs that vary with age and gender (see Appendix 2: Estimated Calorie Needs per Day, by Age, Sex, and Physical Activity Level).

Recommended weekly intakes of nuts, seeds, and soy products, at every calorie requirement levels can be found in the ‘ Dietary Guidelines for Americans’ report.
cRecommended amounts for nuts, seeds, and soy products.
dRecommended amounts for nuts and seeds. Separate recommendations are made for soy products.


In the not too distant past, nuts were considered unhealthy because of their relatively high fat content. Recent research, however, suggests that regular nut consumption is an significant part of a healthful diet. Although the fat content of nuts is relatively high ( grams (g)/ounce), most of the fats in nuts are monounsaturated and polyunsaturated fats rather than saturated fats (see Table 1).

The term «nuts» refers to tree nuts love almonds, Brazil nuts, cashews, hazelnuts, macadamia nuts, pecans, pistachios, and walnuts. Despite their name, peanuts are legumes love peas and beans. However, because they are nutritionally similar to tree nuts, they may share some of the same beneficial properties. Studies mentioned in this article own examined the effects of tree nuts and peanuts either together or separately.


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  Mazidi M, Rezaie P, Ferns GA, Gao HK. Impact of diverse types of tree nut, peanut, and soy nut consumption on serum C-reactive protein (CRP): A systematic review and meta-analysis of randomized controlled clinical trials. Medicine (Baltimore). ;95(44):e  (PubMed)

  Schwingshackl L, Hoffmann G, Missbach B, Stelmach-Mardas M, Boeing H.

An umbrella review of nuts intake and risk of cardiovascular disease. Curr Pharm Des. ;23(7)  (PubMed)

  Bolling BW, Chen CY, McKay DL, Blumberg JB. Tree nut phytochemicals: composition, antioxidant capacity, bioactivity, impact factors. A systematic review of almonds, Brazils, cashews, hazelnuts, macadamias, pecans, pine nuts, pistachios and walnuts. Nutr Res Rev. ;24(2)  (PubMed)

  US Food and Drug istration. Qualified Health Claims: Letter of Enforcement Discretion — Nuts and Coronary Heart Disease (Docket No 02P). 07/09/ Available at: :// Accessed 2/17/ 

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FDA Completes Review of Qualified Health Claim Petition for Macadamia Nuts and the Risk of Coronary Heart Disease. 12/07/ Available at: Accessed 2/17/

  Jiang R, Manson JE, Stampfer MJ, Liu S, Willett WC, Hu FB. Nut and peanut butter consumption and risk of type 2 diabetes in women. JAMA. ;(20)  (PubMed)

  Luo C, Zhang Y, Ding Y, et al.

What is a level 6 nut allergy

Nut consumption and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: a systematic review and meta-analysis. Am J Clin Nutr. ;(1)  (PubMed)

  Zhou D, Yu H, He F, et al. Nut consumption in relation to cardiovascular disease risk and type 2 diabetes: a systematic review and meta-analysis of prospective studies.

What is a level 6 nut allergy

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  Viguiliouk E, Kendall CW, Blanco Mejia S, et al. Effect of tree nuts on glycemic control in diabetes: a systematic review and meta-analysis of randomized controlled dietary trials. PLoS One. ;9(7):e  (PubMed)

  Freisling H, Noh H, Slimani N, et al. Nut intake and 5-year changes in body weight and obesity risk in adults: results from the EPIC-PANACEA study. Eur J Nutr. ;57(7)  (PubMed)

  Flores-Mateo G, Rojas-Rueda D, Basora J, Ros E, Salas-Salvado J. Nut intake and adiposity: meta-analysis of clinical trials. Am J Clin Nutr.

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  Rock CL, Flatt SW, Barkai HS, Pakiz B, Heath DD. Walnut consumption in a weight reduction intervention: effects on body weight, biological measures, blood pressure and satiety. Nutr J. ;16(1)  (PubMed)

  Nieuwenhuis L, van den Brandt PA. Entire nut, tree nut, peanut, and peanut butter consumption and the risk of pancreatic cancer in the Netherlands Cohort Study.

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  van den Brandt PA, Nieuwenhuis L. Tree nut, peanut, and peanut butter intake and risk of postmenopausal breast cancer: The Netherlands Cohort Study. Cancer Causes Control. ;29(1)  (PubMed)

  Hashemian M, Murphy G, Etemadi A, Dawsey SM, Liao LM, Abnet CC. Nut and peanut butter consumption and the risk of esophageal and gastric cancer subtypes.

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  Arab L, Ang A. A cross sectional study of the association between walnut consumption and cognitive function among adult US populations represented in NHANES. J Nutr Health Aging. ;19(3)  (PubMed)

  O’Brien J, Okereke O, Devore E, Rosner B, Breteler M, Grodstein F. Long-term intake of nuts in relation to cognitive function in older women. J Nutr Health Aging. ;18(5)  (PubMed)

  Martinez-Lapiscina EH, Clavero P, Toledo E, et al. Mediterranean diet improves cognition: the PREDIMED-NAVARRA randomised trial. J Neurol Neurosurg Psychiatry. ;84(12)  (PubMed)

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Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA Intern Med. ;(7)  (PubMed)

  Aune D, Keum N, Giovannucci E, et al. Nut consumption and risk of cardiovascular disease, entire cancer, all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis of prospective studies. BMC Med. ;14(1)  (PubMed)

  Grosso G, Yang J, Marventano S, Micek A, Galvano F, Kales SN. Nut consumption on all-cause, cardiovascular, and cancer mortality risk: a systematic review and meta-analysis of epidemiologic studies.

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  Mayhew AJ, de Souza RJ, Meyre D, Anand SS, Mente A. A systematic review and meta-analysis of nut consumption and incident risk of CVD and all-cause mortality. Br J Nutr. ;(2)  (PubMed)

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Nutr J. ;  (PubMed)

  Al-Muhsen S, Clarke AE, Kagan RS. Peanut allergy: an overview. CMAJ. ;(10)  (PubMed)

  Bunyavanich S, Rifas-Shiman SL, Platts-Mills TA, et al. Peanut allergy prevalence among school-age children in a US cohort not selected for any disease. J Allergy Clin Immunol. ;(3)  (PubMed)

  McWilliam V, Koplin J, Lodge C, Tang M, Dharmage S, Allen K. The prevalence of tree nut allergy: a systematic review. Curr Allergy Asthma Rep. ;15(9)  (PubMed)

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  Frazier AL, Camargo CA, Jr., Malspeis S, Willett WC, Young MC. Prospective study of peripregnancy consumption of peanuts or tree nuts by mothers and the risk of peanut or tree nut allergy in their offspring. JAMA Pediatr. ;(2)  (PubMed)

  Maslova E, Granstrom C, Hansen S, et al. Peanut and tree nut consumption during pregnancy and allergic disease in children-should mothers decrease their intake? Longitudinal evidence from the Danish National Birth Cohort.

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en españolAlergia a los frutos secos y a los cacahuetes

What Else Should I Know?

To assist reduce contact with nut allergens and the possibility of reactions in someone with a peanut or tree nut allergy:

  1. Consider making your child’s school lunches, as well as snacks and treats to take to parties, frolic dates, sleepovers, school events, and other outings.
  2. Don’t serve cooked foods you didn’t make yourself, or anything with an unknown list of ingredients.
  3. Work with the childcare supervisor or school principal to make certain the food allergy emergency action plan provided by your allergist is followed correctly.
  4. Tell everyone who handles the food your kid eats, from waiters and waitresses to the cafeteria staff at school, about the allergy.

    If the manager or owner of a restaurant is uncomfortable about your request for peanut- or nut-free food preparation, don’t eat there.

  5. If you hold peanuts and nuts in your home, watch for cross-contamination that can happen with utensils and cookware. For example, make certain the knife you use to make peanut butter sandwiches is not used in preparing food for a kid with a nut allergy, and that nut breads are not toasted in the same toaster as other breads.
  6. Keep epinephrine accessible at every times — not in the glove compartment of your car, but with you. Seconds count during an anaphylaxis episode.

A little preparation and prevention can assist make certain that your child’s allergy doesn’t get in the way of a happy, healthy everyday life.

Located across from the new Longs Drugs location near University Avenue, the Below to Ground store is a destination point for shoppers throughout Honolulu and the the Mo`ili`ili neighborhood.

It opened in , the same year the company was founded, and has 6, square feet. A entire renovation was completed in It offers a variety of natural and organic foods and groceries including dairy products, local organic produce, bulk foods, vitamins and natural supplements, body care products, and household items. The Honolulu store features a deli with boiling food and freezing salad bars, unused juices and smoothies, a grand made-to-order sandwich menu and grab-and-go options and a wide variety of eggless desserts.

We accept every major credit cards.


To discover out more about Below to Ground stores check out our departments.


Parking in the Mo‘ili‘ili Community Middle Parking Lots

Parking for Below to Ground customers is also available in the Mo‘ili‘ili Community Middle parking lot at the rear of our store, however , this is only available during the following hours:

  1. After pm Saturdays
  2. pm – pm Monday to Friday
  3. All day Sundays

Please follow every directions from the Mo`ili`ili Community Middle parking attendant.

Please note that the only entrance to the on-site parking areas is from south King Highway, the parking cannot be accessed from Kuilei Highway or Kapaakea Lane.

Free Parking

  1. Saturday – After 6 p.m.
  2. Monday through Friday – After p.m.
  3. Sunday – Every Day State Holidays

South King Street

There are also 3 parking stalls (one is a handicap stall) in front of the building on the Ewa side of the store. These are available every trade hours, unless coned being used by our delivery trucks.

Second level Parking

Monday — Friday: Free 2hr. parking is provided on the second level via an access ramp on the left side of the store.

Elevators provide simple access during every hours of store operations.

Two-Hour Metered Parking (Makai side of King Street)

  1. Monday through Friday a.m. to p.m.
  2. Saturday a.m. to p.m.

Tow-Away Zone (Beginning March 28th)

  1. Monday through Friday p.m. to p.m.

Handicap Parking

Handicap parking is available at the top of the access driveway to the 2nd level parking, and also in front of South King Street.

British researchers own made significant findings to propose Staphylococcus aureus bacteria on the skin of young children with severe eczema boosts the chances of developing food allergies.

Our study reveals that aside from eczema severity, this bacterium that patients with eczema commonly become colonized with could be an added risk factor for food sensitization and allergy, Dr.

Olympia Tsilochristou, lead author and clinical researcher at Kings College in London, told Allergic Living.

The researchers found that the children with severe eczema with S. aureus colonization (commonly called staph infection) produce more IgE antibodies a marker of allergy to peanut, egg and milk. This indicates sensitization to these foods.

The research team based their findings on data collected during the LEAP study, which followed children at high-risk for peanut allergy (due to having egg allergy or severe eczema or both) from infancy to 5 years of age; then for an additional year in a follow-up study.

Groundbreaking results from that study showed that early introduction of peanut to babies reduced the risk of developing a peanut allergy by 70 to 80 percent.

Bacteria promoting allergy

But in this related study, the researchers found that even if fed peanut from a young age, babies with staph aureus bacteria on the skin and/or in the nose were more likely to develop peanut allergy.

These findings indicate that Staphylococcus aureus may own reduced the chance of young infants gaining tolerance to peanut, even if peanut was eaten in early childhood, said Dr.

George du Toit, the Kings College professor who was co-author of LEAP and of this recent study.

If such children with severe eczema and staph aureusinfection already had an egg allergy, which is often outgrown at a young age, that allergy was also likely to persist longer, according to the study published in the Journal of Allergy and Clinical Immunology.

During the LEAP study, at three age intervals, participants were assessed for eczema severity and IgE antibody levels, and skin and nasal passages were swabbed for the presence of S.

aureus. These data were employed to reach at the new studys conclusions.

The association between staph infections in eczema and peanut allergy has been made previously. However, the new results add a significant understanding to the eczema, staph infection and food allergy relationship, as they are based on findings on a several year population study with highly controlled data. Whats still not clear is the mechanism to get from eczema plus bacteria to food allergy.

Where from here?

So does this mean we may soon see protection against S. aureus infection in eczema considered a food allergy prevention strategy, alongside the early introduction of peanut?

This is a extremely exciting concept and certainly a working hypothesis for future studies, says Tsilochristou.

Interventional studies eradicating S. aureus in early infancy, perhaps alongside early peanut introduction, will assist elucidate its role in the development of food allergy, she said.