Pistachio Allergy: Symptoms, Causes, and Prevention Tips

As pistachios gain popularity for their delicious taste and health perks, it’s important to address the rising concern of a pistachio allergy. In this article, we’ll take a friendly dive into pistachio nut allergies, covering everything from what causes them to how they’re diagnosed and managed.

Whether you’re a devoted pistachio fan or just curious about food allergies, come along as we explore this fascinating topic together!

A zoomed in picture of a variety of pistachio shells.

Understanding A Pistachio Allergy

Having a pistachio allergy means your body’s immune system gets a little mixed up and thinks the proteins in pistachios are harmful. When someone with this allergy eats pistachios or foods with pistachio bits, their immune system gets a bit overprotective and releases histamines, which can cause allergic reactions.

Is pistachio a nut allergy?

Yes, pistachios are classified as tree nuts, and therefore, individuals with tree nut allergies may also be allergic to pistachios. However, it’s important to note that not everyone with a tree nut allergy will necessarily be allergic to pistachios specifically. 

For example, if you have a pistachio allergy, this does not guarantee that you will also be allergic to almonds (or other tree nuts). 

How common are pistachio allergies?

Pistachio Allergy Fact Infographic: About 7% of the population in the United States has a pistachio allergy.

Pistachio allergies are fairly common, about 7% of the U.S. population is allergic to pistachio nuts. This allergy is even more prevalent in Europe with an estimated 1 out of 10 people in France, and 2 out of 10 people in the Netherlands.

Pistachio Allergies Can Develop at Any Age

A younger lady and an older man sitting on the bench holding hands on a windy fall day.

Pistachio nut allergies can develop at any age but are more commonly seen during childhood.  Kids with relatives who have allergies, especially to nuts, might be more likely to develop allergies to pistachios or other nuts. However, adults who’ve never had nut allergies before could also develop them as they get older.

Outgrowing A Pistachio Allergy

Outgrowing a pistachio allergy is possible for children and adults. Our allergies, immune systems, and exposures can change over time, which can all be factors in “outgrowing” allergies. 

The likelihood of outgrowing an allergy has mixed reviews, but it may (or may not) happen. Outgrowing an allergy takes a “wait and see” approach. 

Causes and Risk Factors

Pistachio allergy Risk Factors Infographic. Experiencing any of these risk factors can either prompt the onset of an allergy or increase the chances of its occurrence: Age, Eczema, Exposure to Allergens, Family History, Immune System Health, and Other Allergies.

Numerous factors contribute to the onset of a pistachio allergy, warranting careful consideration. Having one or more of these risk factors can either trigger the development of an allergy or elevate the likelihood of its occurrence:

  • Age: Children are more commonly affected by nut allergies, including pistachios. However, adults can also develop new allergies later in life.
  • Eczema: People with eczema (atopic dermatitis) may have a higher risk of developing food allergies, including pistachio allergies.
  • Exposure to Allergens: Increased exposure to pistachios or pistachio dust, either through consumption or environmental exposure, can increase the risk of developing an allergy.
  • Family History: Individuals with a family history of nut allergies, including pistachios, are at a higher risk of developing an allergy themselves.
  • Immune System Health: The overall health of the immune system can play a role in the development of allergies.
  • Other Allergies: Individuals with other allergies, such as hay fever or asthma, may be at a higher risk of developing food allergies, including pistachio allergies.

Symptoms & Reactions

Pistachio allergy symptoms infographic. Although this list is not all inclusive, these are 20 possible pistachio allergy symptoms: Abdominal pain, Anaphylaxis, Anxiety , Coughing, Diarrhea, Difficulty breathing, Dizziness, Fainting, Fatigue, Headache, hives, Itching in the mouth, Low blood pressure, Nasal congestion , Nausea, Rapid heartbeat, runny nose, Skin rash , Sneezing, Swelling of the face, Swelling of the mouth , Vomiting, and wheezing.

Pistachio allergies can manifest with a range of symptoms, ranging from mild to severe, shortly after exposure to pistachios or products containing pistachio ingredients. Common symptoms and reactions of pistachio allergies include:

  • Abdominal pain or cramping
  • Anaphylaxis (a severe allergic reaction affecting multiple systems)
  • Anxiety or panic attack
  • Coughing
  • Diarrhea
  • Difficulty breathing or wheezing
  • Dizziness
  • Fainting
  • Fatigue
  • Headache
  • Itching or tingling sensation in the mouth or throat
  • Low blood pressure
  • Nasal congestion or runny nose
  • Nausea
  • Rapid heartbeat
  • Skin rash or hives
  • Sneezing
  • Swelling of the face, eyes, or extremities
  • Swelling of the lips, tongue, or throat
  • Vomiting

Diagnosing Pistachio Nut Allergies

A doctor taking notes while talking with a patient about their medical treatment options.

Identifying a pistachio nut allergy usually entails a blend of medical background assessment, physical examination, and specialized allergy testing. Here are the typical procedures involved in diagnosing a pistachio nut allergy:

Blood Tests

Blood assessments, like specific IgE (immunoglobulin E) tests, gauge the quantity of antibodies generated by your immune system in reaction to pistachio allergens. Heightened levels of IgE antibodies targeting pistachio proteins may suggest an allergy.

Elimination Diet

If your physician suspects a pistachio allergy but test results are inconclusive, they might advise removing pistachios and other nuts from your diet temporarily to assess symptom improvement. Reintroducing pistachios later can assist in confirming the diagnosis if symptoms resurface.

Medical History & Exam

Your doctor will conduct a thorough medical history and routine exam to assess your symptoms to determine if they are allergy related. Specifically, your provider may be looking for:

  • Gastrointestinal issues: vomiting, nausea or diarrhea
  • Respiratory problems: wheezing, or difficulty breathing
  • Skin reactions: hives or eczema

Oral Food Challenge

In some cases, your doctor may recommend an oral food challenge, especially if the results of skin prick tests and blood tests are inconclusive or conflicting. During an oral food challenge, you’ll be given increasing amounts of pistachio nuts under medical supervision to observe any allergic reactions.

Skin Prick Test

This is among the prevalent allergy examinations employed to identify pistachio nut allergies. During this procedure, tiny quantities of pistachio nut extract are applied to your skin, typically on your forearm or back. Subsequently, the skin is punctured with a small needle to facilitate the entry of the extract into the skin.

If you have a pistachio allergy, you may observe the emergence of a raised, red bump (known as a wheal) at the application site within 15-20 minutes.

It’s crucial to seek guidance from a certified healthcare provider, like an allergist or immunologist, for accurate diagnosis and treatment of an allergy to pistachio nuts. They will customize the diagnostic process according to your specific medical background and symptoms.

Treating & Managing Pistachio Allergies

Pistachio Allergy Treatment & Management Infographic. Individuals with pistachio allergies should familiarize themselves with treatment and management options. Below are typical steps involved in addressing pistachio allergies with a healthcare professional: Allergen Immunotherapy, Allergy Medications, Avoiding Pistachios, Emergency Action Plan, Emergency Medications, Medical, Alert Bracelet or Necklace (When required).

People with an allergy to pistachios will need to understand and discuss with their doctor treatment and management processes. Here is a list of common steps used in the treatment of pistachio allergies:

  • Allergen Immunotherapy: Allergy shots (subcutaneous immunotherapy) or oral immunotherapy (OIT) may be recommended for individuals with severe allergies who want to reduce their sensitivity to pistachio allergens over time.
  • Allergy Medications: Antihistamines and corticosteroids can help alleviate symptoms like itching, hives, and runny nose.
  • Avoidance: The most effective way to prevent allergic reactions to pistachios is to avoid consuming pistachio nuts and products containing pistachio ingredients.
  • Emergency Action Plan: Individuals with a pistachio allergy should educate themselves and their caregivers about their allergy.
  • Emergency Medications: In case of a severe allergic reaction (anaphylaxis), an epinephrine auto-injector should be carried at all times.
  • Medical Alert Bracelet or Necklace: Wearing a medical alert bracelet or necklace that identifies the individual as having a pistachio allergy can be helpful in emergency situations.

Living with A Pistachio Allergy: Tips and Advice

Living with a pistachio allergy requires vigilance and careful planning to avoid potential allergic reactions. The biggest pieces of advice after you have been properly diagnosed with a pistachio allergy are to avoid pistachios as much as possible, carry your medications with you, and communicate your allergies with those around you. 

Avoid Pistachio Cross-Reactive Foods

Pistachio Allergy Foods to avoid infographic. The foods to avoid with an allergy to pistachios are: Almonds, Brazil nuts, Cashews, Figs, Hazelnuts, Kiwi, Mangoes, Peanuts, Peas, Poppy seeds, Sesame seeds, Soybeans, Sunflower seeds, and Walnuts.

Cross-reactivity occurs when the proteins in one food are similar to those in another, leading to allergic reactions in individuals with certain food allergies. For individuals allergic to pistachios, cross-reactivity may occur with other foods that share similar proteins. Foods that are commonly cross-reactive to pistachios include:

  • Certain Seeds: Sesame seeds, poppy seeds, and sunflower seeds may cross-react with pistachios in some individuals.
  • Fruits: Some fruits, such as kiwi, figs, and mangoes, may cross-react with pistachios due to shared protein structures.
  • Legumes: Legumes like soybeans and peas may also cross-react with pistachios in individuals with allergies.
  • Peanuts: While peanuts are legumes and not tree nuts, they can also cross-react with pistachios in some cases.
  • Tree Nuts: Other tree nuts such as almonds, cashews, walnuts, hazelnuts, and Brazil nuts may trigger allergic reactions in individuals allergic to pistachios.

Be Cautious of Cross-Contamination

 Be aware of cross-contact, where pistachio residues can unintentionally transfer to other foods through shared equipment, utensils, or surfaces. Choose restaurants or food establishments with strict allergen protocols.

Carry Medication

Keep your prescribed, and OTC antihistamine medication, such as an epinephrine auto-injector (e.g., EpiPen), with you at all times. Ensure that family members, friends, or colleagues know how to administer it in case of an emergency.

Communicate Clearly

A woman standing in a street with a megaphone, trying to communicate her message.

When dining out or purchasing food, communicate your pistachio allergy to restaurant staff, chefs, or food vendors. Ask about ingredient lists and food preparation methods to ensure pistachios are not present and cross-contamination is avoided.

Educate Others

Educate those around you, including friends, family, caregivers, teachers, and coworkers, about your pistachio allergy. Teach them how to recognize allergic reactions and how to respond appropriately.

Explore Alternative Ingredients

Experiment with alternative ingredients and recipes to replace pistachio nuts in your diet. There are many nutritious and delicious alternatives available. Luckily pistachios are not usually a staple ingredient in many recipes, so finding an alternative should be pretty straightforward.

Plan Ahead

When attending social gatherings, parties, or events, inquire about the menu in advance and bring safe snacks or meals if necessary. Being prepared can help you avoid accidental exposure to pistachio nuts.

Read Food Labels

A tin with a lid that states "nut-free" on the top.

Always read food labels carefully to identify if products contain pistachio nuts or any pistachio-derived ingredients. Manufacturers are required to clearly label common allergens, including nuts.

Wear Medical Identification 

Silver medical alert bracelet, clasped closed.

Consider wearing a medical identification bracelet or necklace that indicates your pistachio allergy. This can alert medical professionals to your condition in case of an emergency.

You can have custom pistachio allergy ID bracelets made on Amazon at a very affordable price.

By incorporating these strategies into your daily routine and remaining proactive about managing your pistachio allergy, you can navigate various situations safely and confidently.