Pecan allergy

By Symon, Every Label · June 30, 2026

Pecan allergy is an IgE-mediated immune reaction to the seed-storage proteins in Carya illinoinensis, the pecan tree, and it is among the more frequently severe tree-nut allergies. In plain terms: your child’s immune system reads certain pecan proteins as a threat, and a reaction can run from hives to a whole-body allergic reaction that affects breathing and blood pressure, called anaphylaxis. It is a true allergy, not a sensitivity or an intolerance. Tree-nut allergy affects roughly 1.2 percent of US children (Gupta 2018), with pecan among the more frequently named and more frequently severe tree nuts in North America. Unlike egg or milk, pecan is rarely outgrown, and there is one botanical cousin you need to know about from the start: walnut.

If your child was just diagnosed, read this first.

This page is long on purpose. It is also the page you will come back to for years. You do not need all of it today. This week, this is what matters:

• Carry the epinephrine your allergist prescribes everywhere your child goes, and learn the few signs that mean use it now. That is the section to read tonight (Emergency preparedness, below). If you do not have the prescription yet, that is the first call to your allergist or pediatrician.
• Read every label, every time. The words to catch are pecan, pecans, and Carya, and because walnut travels with pecan, walnut and walnut-derived terms too (Reading labels, below).
• Pecan and walnut travel together. They are the two closest tree nuts (the same Juglandaceae family) and they cross-react very strongly, so treat walnut (and hickory) as off the list too until an allergist tells you otherwise (Cross-reactivity, below).
• The other tree nuts are a separate question, not an automatic yes and not an automatic no. They are tested, not assumed (Cross-reactivity, below).
• You do not have to understand the protein science to keep your child safe. The components and the test results are for unhurried conversations with your allergist.
• Ask your allergist about the one high-value test by name: Car i 1 (Components, below).

Everything else here is waiting for you, in roughly the order the questions tend to come up. Read it when you want it.

Where a fact below is clinical, it carries its source. None of it is a substitute for your allergist.

What pecan allergy is, and who has it

Pecan allergy is an IgE-mediated immediate-type food allergy, and pecan is among the tree nuts most often linked to severe, whole-body reactions (Sicherer 2018). That is the reason for everything practical on this page: the auto-injector, the label habit, the written plan. When your child eats pecan, IgE antibodies on their immune cells latch onto the pecan proteins and trigger a release of histamine and other chemicals within minutes. That release is the reaction.

Pecan is a true tree nut, in the plant family Juglandaceae. That family matters more than it does for most allergens, because its other member you are likely to meet on a plate is walnut, and pecan and walnut cross-react more strongly than almost any other pair of foods (Cross-reactivity, below). Hickory is in the same genus (Carya) and is treated with the same caution. This is different from peanut, where the family overlap (with other legumes) is mostly reassuring. For pecan, the family is part of the caution.

Tree-nut allergy runs about 1.2 percent in US children (Gupta 2018, a nationally representative survey of 38,408 children, parent-reported and not challenge-confirmed) and about 1.8 percent in US adults (Gupta 2019), and pecan is consistently among the more frequently reported and more frequently severe individual tree nuts in North America, where it is most consumed. A clean pecan-specific, challenge-confirmed prevalence is not separately published, so that figure is the tree-nut-group number carried with that qualifier rather than a single pecan percentage. Onset is usually early childhood, and tree-nut allergy including pecan is frequently lifelong, so the absence of a previous reaction does not mean a child is in the clear.

Diagnosis combines your child’s history with testing, and for pecan the testing has one high-value move worth knowing about. The next section is what it is.

The components that drive severity

Pecan is not one thing to the immune system. It is a handful of proteins, and which one your child reacts to changes how serious the allergy tends to be. For pecan there is one marker that carries most of the weight, and asking for it by name is the highest-value thing you can do.

A standard pecan test (the skin prick, or the basic blood test) only tells you the immune system has noticed pecan at all, and on its own it over-diagnoses, because the same child often tests positive to several unrelated nuts while truly reacting to only one or a tight pair. A more detailed test, component testing, breaks that down protein by protein. For pecan the protein that matters most is the one your allergist calls Car i 1. It is the strongest signal for the serious, whole-body kind of pecan allergy. Unlike peanut, pecan does not have a well-established “usually mild” component to reassure you with, and there is no single magic pecan number to decode; the pecan picture is mostly about whether the Car i 1 signal is there and how strong it is.

So the high-value move is simple: ask your allergist to measure Car i 1-specific IgE (or the near-identical walnut Jug r 1, which labs often use as the stand-in for this protein family), not just whole-pecan IgE, and ask what the result means for severity and for the chance of outgrowing it. You do not need to learn the protein names or the lab numbers yourself. They are below, written so the words on your child’s lab report mean something when you want them to.

Cross-reactivity, real and cautionary

This is the section where pecan, like its tree-nut cousins, leads with the caution rather than a reassurance, because the honest version of pecan’s cross-reactivity changes what is on your child’s plate. The good news that does exist is narrow and specific, and it comes after the part that actually matters.

Walnut travels with pecan. Pecan and walnut are the two most closely related tree nuts (the same Juglandaceae family), and they cross-react very strongly through near-identical storage proteins (pecan Car i 1 and Car i 4, walnut Jug r 1 and Jug r 4). Roughly 9 in 10 people allergic to one react to the other, and reactions can be severe. Treat walnut as off the list unless an allergist-supervised challenge says otherwise, and confirm tolerance that way, never by trying walnut at home. Hickory sits in the same genus (Carya) and is treated with the same caution.

A positive storage-protein test is a red flag, not a minor finding. If component testing comes back positive to a pecan storage protein (Car i 2 or Car i 4), or to the matching storage proteins in walnut, cashew, or pistachio, that is a signal for whole-body reactions, not a reassuring low-risk result. These proteins are heat-stable and survive digestion, so roasting, baking, or cooking does not make the nut safe. Treat a positive as a reason for strict avoidance and an epinephrine plan, and confirm any tolerance only with your allergist.

Hazelnut is a real co-allergy question. Hazelnut, pecan, and walnut allergies frequently occur together. So hazelnut is not something to assume safe on a pecan allergy; it is a question for your allergist to test.

What the science does NOT yet let us reassure you about. Whether a pecan-allergic child can safely eat the other, less related tree nuts (cashew, pistachio, almond, macadamia, Brazil nut) is a real and common question, and the honest answer right now is that it is tested, not assumed. A pecan allergy does not reliably predict reactivity to the botanically unrelated cashew and pistachio (a different family, the Anacardiaceae) or to almond, where component testing frequently narrows a child labeled “allergic to all tree nuts” down to a much smaller true-reactivity set. But that narrowing is the allergist’s work with the test results, nut by nut. A blanket “you can eat the rest” is not something this page will tell you, because the evidence does not support it.

The one clear reassurance: coconut. Coconut, despite the name and the FDA’s labeling rule, is botanically a fruit (a drupe), not a tree nut, and most tree-nut-allergic people tolerate it. Coconut is usually a yes, confirmed with your allergist.

Hidden sources

Pecan hides in desserts and in premium baking more than it announces itself, so these are worth a one-time read now; after that you will spot them on your own.

Pralines, pies, and butter-pecan. Pecan is the defining nut in pecan pralines, pecan pie, candied or praline pecans, and butter-pecan ice cream, and it hides in baked goods, flours, nut butters, flavorings, and coffees. Butter-pecan flavoring is a real pecan exposure, not only a name, so treat it as a pecan source. Because Car i 1 is heat-stable, baked and candied forms keep their risk.

Mixed-nut products, baked goods, and ice creams. Pecan turns up as an unlabeled or easy-to-miss ingredient in mixed-nut products, nut meals and flours, cookies, coffee cakes, and ice creams and confections. Read the ingredient list and any “may contain tree nuts” advisory, and ask in bakeries where nut and nut-free items share equipment.

Walnut-derived ingredients (the cross-reactive cousin). Because pecan and walnut cross-react so strongly, a pecan-allergic family scanning a label also treats walnut-derived ingredients as relevant: nut meal, gourmet or unrefined nut oil, and nut paste. The walnut-dense settings, baklava, walnut-studded salads and stuffings, and pesto where walnut substitutes for pine nuts, are pecan-relevant for the same reason.

Suspicious flavoring terms. Praline (in the US sense, classically pecan), nut meal and nut flour (which may be pecan), gianduja and nut pastes, and natural flavoring (which can mask a nut-derived flavoring where ingredient transparency is limited) all warrant a closer look or a call to the manufacturer.

How exposure actually happens

The routes parents fear most are usually not the ones that cause serious reactions. Eating pecan is. The rest are lower-risk than they feel.

Eating it (high). Swallowing pecan protein is the route that causes whole-body reactions. Everything else is far behind it. Cooking does not help: pecan’s main storage protein (Car i 1) is heat-stable, so roasted, baked, candied, and glazed pecan all stay allergenic.

Skin contact (low, higher with broken skin). Pecan on intact skin usually causes at most a local reaction. Broken or eczematous skin is the situation where any skin contact carries more risk.

Breathing it in (low). Pecan is not volatile the way shellfish cooking aerosols are, so ambient smell is low-risk in ordinary life, and pecan carries no operative cooking-vapor route. Aerosolized pecan dust in bulk-processing or occupational settings is a different, higher-exposure situation than a kitchen.

There is no pecan vaccine, anaesthesia, or medication consideration to flag here; pecan, unlike some allergens, carries no documented medical-setting (iatrogenic) exposure of that kind. If your child needs a procedure or a vaccine, the standing advice to tell every provider about any food allergy still applies, but there is no pecan-specific medication caution this page needs to raise.

Reading labels

This is the habit that does the most day-to-day work, and it gets fast. The words to scan for are pecan, pecans, and Carya (the genus). In the US, tree nuts including pecan must be named specifically under FALCPA, so a label declares pecan by name; the EU and UK require tree-nut declaration under Regulation 1169/2011, with pecan named (FALCPA; EU 1169). Because pecan and walnut cross-react so strongly, a pecan-allergic family also scans for walnut and walnut-derived terms.

A few terms are signals to slow down: butter-pecan flavoring (a real pecan exposure, not just a name), praline and pralines (classically pecan in the US sense), nut meal and nut flour (which may be pecan), gianduja and nut pastes, and natural flavoring (which can mask a nut-derived flavoring where ingredient transparency is limited). When a term is unclear and the manufacturer will not say, treat it as a reason to call the company, not a reason to assume it is safe.

Then there are the precautionary labels: “may contain tree nuts,” “made in a facility that processes tree nuts.” These are voluntary and unregulated in both the US and the EU, so they are not a reliable measure of how much risk is actually present, and because walnut and pecan are tightly linked, a tree-nut precautionary statement is treated as pecan-relevant. How strictly you treat them is a personal call along a spectrum, weighing a real but variable cross-contact risk against ruling out a large share of the grocery store. This page will not pick that threshold for you.

Severity, and what predicts a bad reaction

The strongest population-level predictor of a severe pecan reaction is sensitization to the 2S albumin Car i 1, the protein from the components section (and, by the very high cross-reactivity, the near-identical walnut Jug r 1). A history of a previous severe reaction is the next strongest input. Pecan is storage-protein-dominated, heat-stable, and digestion-stable, which is the mechanistic reason it carries anaphylaxis risk across cooked, roasted, and baked forms. General cofactors (exercise, NSAIDs, alcohol, intercurrent illness) can lower the reaction threshold on a given day, as they can for most food allergens.

Here is the part that justifies always carrying epinephrine. The size of the last reaction does not reliably predict the next one, and pecan reactions can be severe. A child whose only reaction so far was mild can still have anaphylaxis next time. That is not a reason to live in fear; it is the single reason the auto-injector travels everywhere.

Emergency preparedness

Pecan anaphylaxis is treated epinephrine-first. Epinephrine is the first-line treatment for a severe reaction, not an antihistamine and not a wait-and-see. If you see anaphylaxis, you give epinephrine and then you call emergency services.

The signs that mean epinephrine now include any two body systems reacting at once (for example hives plus vomiting), or any single severe sign on its own: trouble breathing, throat tightness, a hoarse or weak cry, repetitive coughing, pale or floppy appearance, or a sense of impending doom in a child old enough to say so. When you are unsure, the guidance is to give epinephrine, because the danger of withholding it in a true reaction is far greater than the danger of giving it when it turns out you did not need to.

After giving epinephrine, call emergency services and lay the child down with legs raised, unless breathing is the main problem, in which case let them sit up. A second dose may be needed if there is no improvement in about five minutes. Every pecan-allergic child should have a written anaphylaxis action plan and two epinephrine auto-injectors that go everywhere the child goes.

This section is general. Your child’s own plan is the specific one, and it is the one to follow.

When you can’t tell what’s happening

The hardest moments are usually not the clear reactions. They are the ambiguous ones. A flushed cheek after a new food. A single cough. A child who says their tummy hurts an hour after a snack you did not pack. Telling the start of a reaction apart from an ordinary toddler complaint is genuinely hard, and it does not resolve cleanly from across the room.

The posture that works is to treat the spectrum, not to diagnose it in the moment. Know your action plan’s override signs cold, watch whether more than one body system is involved rather than fixating on a single symptom, and accept that you will sometimes give epinephrine or call the allergist for something that turns out to be nothing. That is the system working the way it is supposed to.

The competence here builds slowly, over many ambiguous afternoons. It shows up as a shorter pause before you act.

Treatment options

Strict avoidance is the floor, and everything else is decided on top of it. Avoidance plus a written action plan plus epinephrine within reach is the standing setup for pecan-allergic children. Because walnut travels with pecan (see Cross-reactivity), avoidance practically extends to walnut (and hickory) unless a supervised challenge specifically demonstrates tolerance.

There is one important difference from a generation ago: there is now an FDA-approved medication that can reduce the severity of reactions to accidental food exposure, though it is not a cure and it is not a way to make pecan safe to eat.

Omalizumab (Xolair), the approved adjunct. Omalizumab is an anti-IgE injection that was FDA-approved in February 2024 to reduce IgE-mediated allergic reactions to one or more foods, including tree nuts, in people aged 1 year and older (FDA 2024). It is a protective add-on against accidental exposure, not a cure and not a desensitization: it does not make pecan safe to eat, and strict avoidance and the epinephrine plan still stand. Whether it fits a particular child is a benefit-versus-burden conversation with your allergist along a spectrum of effect, cost, and the burden of regular injections. This page does not prescribe it for any one child.

Pecan and tree-nut oral immunotherapy (investigational, not approved). Oral immunotherapy feeds measured, slowly increasing doses of a food protein under medical supervision to train the body toward tolerance. For pecan there is no approved product and no standard-of-care protocol: tree-nut OIT appears in the literature only inside investigational research protocols, often multi-nut, and offered in a limited number of specialist centers. Cross-nut desensitization is family-specific, not general: in controlled study, hazelnut OIT did not cross-desensitize to cashew and was unlikely to cross-desensitize to walnut, so a pecan-allergic child is not protected by OIT to an unrelated nut (Elizur 2025). Within Juglandaceae, walnut and pecan share near-identical storage proteins, so a walnut protocol would be expected to act on the shared epitope, but a pecan-specific or walnut-to-pecan tolerance protocol is not documented at a level this page can stand on. The clinical default remains strict avoidance, and this page does not name a dose or prescribe a path. Whether a research option is appropriate is a conversation with your child’s allergist.

The broader pipeline. Epicutaneous (patch) immunotherapy, additional biologics in trial, and multi-nut OIT protocols continue to be studied. None is an approved pecan-specific therapy today; the landscape is in flux and is tracked with your allergist over time, not prescribed here.

Not medical advice. Whether to treat at all, and how, is a conversation with your allergist.

Day-to-day living

School and day care. A pecan-allergic child needs a written plan on file, epinephrine truly accessible, trained staff, and a clear routine for snacks, classroom parties, baking projects, and substitute teachers. In US public schools, a 504 plan is the usual way to put that in writing. Flag walnut (and hickory) alongside pecan, because they travel together.

Restaurants. The risk is cross-contact and hidden pecan more than the obvious menu item. Bakeries, dessert spots, ice-cream counters, and anywhere serving pralines, pecan pies, or candied nuts carry higher pecan risk. A chef card that names pecan and walnut plainly does more than a verbal order across a loud kitchen.

Travel. Bring more epinephrine than you think you need, carry food you trust, and look up pharmacies and emergency numbers before you land. Pecan is common in North American baked goods and desserts, so confirm local dishes carefully.

Holidays and gatherings. Mixed-nut bowls, pecan pies and pralines, butter-pecan ice cream, candied nuts, and walnut-studded salads, stuffings, and baklava are the pecan-dense and walnut-dense settings. Bringing your child’s own food and being plain with hosts beats hoping a buffet is safe.

Prognosis and outgrowing

Pecan is among the more persistent food allergies. It is outgrown in only a minority of children: the classic estimate is that roughly 9 to 10 percent of children with tree-nut allergy outgrow it as a group, lower than the rate for egg or milk and broadly comparable to peanut (Fleischer 2005). A pecan-specific challenge-confirmed outgrowth percentage is not separately published, so that is the tree-nut-category figure carried with that qualifier rather than a precise pecan number. The more reliable early sign of outgrowing, by analogy to the storage-protein nuts, is a low or falling 2S albumin (Car i 1, or the homologous walnut Jug r 1) specific IgE over serial testing, along with a shrinking skin-prick wheal; a high or rising value predicts persistence.

Reassessment cadence is individualized, commonly considered every one to a few years where the trajectory is favorable and the reaction history is mild, and more cautiously after a severe reaction. The one definitive test of outgrowing it is a supervised oral food challenge; falling numbers are encouraging but supportive, not proof.

Questions for your allergist

You do not have to walk in knowing the science. You have to walk in with the right questions, and these are them.

1. What is my child’s Car i 1-specific IgE value (or the walnut Jug r 1 stand-in), not just whole-pecan IgE, and what does its level and its trend mean for severity and for outgrowing?
2. If my child reacts to pecan, should we treat walnut (and hickory) as off-limits too, and should component testing guide how strict to be?
3. Does a pecan allergy mean my child is allergic to all tree nuts, or could testing show they tolerate cashew, pistachio, or almond?
4. Is hazelnut a real question for my child given the pecan overlap, and which other tree nuts should we actually test rather than assume?
5. Is butter-pecan flavoring or praline a real pecan exposure for my child, or just a name?
6. There is no approved pecan immunotherapy. Would omalizumab change anything for accidental exposure for us, and are any investigational tree-nut or walnut OIT options relevant?
7. When and how should we reassess to see if the allergy is resolving?
8. What will epinephrine, and any treatment we are considering, actually cost us, and what does our insurance cover?

The frame: how to hold this

There are two worlds, and a severe food allergy moves a family from one into the other. In the recoverable world, a mistake is a lesson. A forgotten jacket is a cold afternoon. In the irrecoverable world, one wrong protein is not a lesson, because the cost of the error can be the child. When someone tells an allergy parent to relax, they are speaking from the first world to someone who has had to move to the second. They think the parent is anxious. The parent is not anxious. The parent is calibrated.

The work, then, is to sort what is on your side of the line from what is not. On your side: the labels you read, the Car i 1 test you ask for, the epinephrine that travels with the child, the chef card that names pecan and walnut, the plan on file at school. Not on your side: the kitchen that folds pecan into a praline or a pie crust and does not say so, the relative who thinks one bite is kindness, the manufacturer whose precautionary label is voluntary. You do the things on your side fully, and you stop apologizing for them. And you hold, without pretending otherwise, that the other side is real and partly random, and that a stacked defense reduces the risk without ever closing the gap to zero.

This page does not promise safety. It lays out the layers and names the gap, and it leaves the calibration to you and your allergist, who actually know your child.

Voices: living with pecan allergy

Attributed lived experience, kept separate from the clinical facts above. These are individual accounts, not medical guidance, and they carry no clinical claim the page above has not already made.

Writing about the “food allergy dark ages” before ingredient labels, one author recounts growing up in the 1970s with severe allergies to Brazil nuts, almonds, pistachios, pecans, pralines, and peanuts. By age four she was aware of them, and she recounts her first anaphylactic reaction in 1971, crediting her mother with keeping her safe in the years before anaphylaxis was widely understood.

Source: Tamar Evangelestia-Dougherty, Allergic Living, 2017. https://www.allergicliving.com/2017/05/12/stayin-alive-in-the-70s-before-allergy-labels-there-was-mom/ One person’s experience, not medical guidance.

A Mississippi teen with a pecan allergy was handed a pastry his mother believed was a nut-free cinnamon twist; it was a pecan braid. After a couple of bites he crunched down on something hard, felt a stabbing sensation on his tongue and burning in his mouth, and went into a prolonged anaphylactic reaction that required several shots of epinephrine. He later developed anxiety and was diagnosed with PTSD.

Source: Trevor Gartman, as reported in Allergic Living, 2022. https://www.allergicliving.com/2022/01/12/severe-snack-reaction-a-teens-trauma-and-food-allergy-lawsuit/ One person’s experience, not medical guidance.

A teen with allergies to tree nuts including pecan writes about reaching the point in oral immunotherapy where butter pecan ice cream, once off-limits, became something he could choose: “there, in the back right corner, sat a tub of butter pecan ice cream.”

Source: Jake Kaplan, FARE (Food Allergy Research and Education), 2024. https://www.foodallergy.org/fare-blog/how-oral-immunotherapy-changed-everything This was one person’s experience with oral immunotherapy; do not try this without your allergist.

Frequently asked questions

If my child is allergic to pecan, do they have to avoid walnut?

Usually yes, until an allergist says otherwise. Pecan and walnut are the two most closely related tree nuts (the same Juglandaceae family) and they cross-react very strongly, so roughly 9 in 10 people allergic to one react to the other. Treat walnut, and hickory, as off the list unless a supervised challenge shows tolerance.

Which pecan test should I ask for?

Ask your allergist to measure Car i 1-specific IgE (or the near-identical walnut Jug r 1 stand-in), not just whole-pecan IgE. Car i 1 is the strongest signal for the serious, whole-body kind of pecan allergy, and it is read against your child’s history rather than as a single magic number.

Is there a treatment for pecan allergy?

There is no approved pecan immunotherapy and no way to make pecan safe to eat. Omalizumab (Xolair), FDA-approved in 2024, can reduce reactions to accidental exposure as an add-on, not a cure. Strict avoidance plus a written action plan plus epinephrine within reach stays the floor, decided with your allergist.

Can my child outgrow a pecan allergy?

Usually not. Pecan is among the more persistent allergies, and only a minority of children outgrow tree-nut allergy as a group, roughly 9 to 10 percent. The one definitive test of outgrowing it is a supervised oral food challenge, with reassessment timing decided by your allergist.

References and medical review

This page is pending independent medical review; the note at the top of the page applies until a reviewer is assigned. The references below resolve every in-body citation. The cross-reactivity, component, hidden-source, and reassurance claims (walnut travels with pecan, the storage-protein red-flag rule, the hazelnut co-allergy, the pralines and desserts hidden sources, and the coconut reassurance) are drawn from the project’s verified cross-reactivity and hidden-source floor, each carrying its own source there.

1. Gupta RS, Warren CM, Smith BM, et al. The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States. Pediatrics. 2018;142(6):e20181235. https://doi.org/10.1542/peds.2018-1235 (tree-nut class prevalence about 1.2 percent of US children; pecan not separately enumerated)
2. Gupta RS, Warren CM, Smith BM, et al. Prevalence and Severity of Food Allergies Among US Adults. JAMA Netw Open. 2019;2(1):e185630. https://doi.org/10.1001/jamanetworkopen.2018.5630 (tree-nut about 1.8 percent of US adults; pecan not separately enumerated)
3. Sicherer SH, Sampson HA. Food allergy: a review and update on epidemiology, pathogenesis, diagnosis, prevention, and management. J Allergy Clin Immunol. 2018;141(1):41-58. https://doi.org/10.1016/j.jaci.2017.11.003
4. Goetz DW, Whisman BA, Goetz AD. Cross-reactivity among edible nuts. Ann Allergy Asthma Immunol. 2005;95(1):45-52. https://doi.org/10.1016/s1081-1206(10)61187-8 (the tight walnut and pecan Juglandaceae cross-reactivity; basis for the treat-as-one framing)
5. Santos AF, Riggioni C, Agache I, et al. EAACI guidelines on the diagnosis of IgE-mediated food allergy. Allergy. 2023;78(12):3057-3076. https://doi.org/10.1111/all.15902 (skin-prick and specific-IgE screening, component interpretation, and the oral food challenge as the reference standard)
6. Fleischer DM, Conover-Walker MK, Matsui EC, Wood RA. The natural history of tree nut allergy. J Allergy Clin Immunol. 2005;116(5):1087-1093. https://doi.org/10.1016/j.jaci.2005.09.002 (about 9 to 10 percent of tree-nut-allergic children outgrow it as a group; no pecan-specific figure)
7. Elizur A, Appel MY, Goldberg MR, et al. Hazelnut Oral Immunotherapy Desensitizes Hazelnut But Not Other Tree Nut Allergies (Nut CRACKER Study). J Allergy Clin Immunol Pract. 2025;13(4):833-841.e4. https://doi.org/10.1016/j.jaip.2024.12.041 (cross-nut desensitization is family-specific; hazelnut OIT did not cross-desensitize to cashew and was unlikely to to walnut)
8. US FDA. FDA approves first medication (omalizumab, Xolair) to help reduce allergic reactions to multiple foods after accidental exposure (approved February 2024, ages 1 and up). https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-help-reduce-allergic-reactions-multiple-foods-after-accidental
9. Togias A, Cooper SF, Acebal ML, et al. Addendum guidelines for the prevention of peanut allergy in the United States (NIAID-sponsored expert panel; cited for the anaphylaxis triage-escalation default and the reassessment-cadence framing). J Allergy Clin Immunol. 2017;139(1):29-44. https://doi.org/10.1016/j.jaci.2016.10.010
10. Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA), Title II of PL 108-282 (tree nuts declared by specific nut name, so pecan is declared as pecan). https://www.fda.gov/food/food-allergensgluten-free-guidance-documents-regulatory-information/food-allergen-labeling-and-consumer-protection-act-2004-falcpa
11. Regulation (EU) No 1169/2011 (Annex II allergens, tree nuts including pecan). https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A32011R1169
12. Cross-reactivity, component, hidden-source, and reassurance claims above resolve to the project’s verified floor: walnut travels with pecan (GREEN, very high, the Section lead), the tree-nut storage-protein red-flag rule, the hazelnut and pecan co-allergy, the pralines and desserts hidden-source list, and the coconut reassurance. Each carries its own tier-1 citation in the floor file.