Pistachio Allergy - Symptoms, Treatment, Rash, Cross reactivity

Pistachio Allergy – Symptoms and Treatment

Pistachios are tiny tree nuts. Along with cashews, they are a part of the mango nut family. Pistachio allergy usually develops during the early stages of life and generally persists for the lifetime of the affected individual. Pistachio allergy symptoms can arise due to exposure to even very small quantities of the nut.

Rashes and itchy skin are the most common symptoms experienced by people with pistachio allergy.Other symptoms include itchy and watery eyes, sneezing, and coughing. Some may elicit gastrointestinal symptoms such as diarrhea and/or nausea, while some others may develop hives or asthma symptoms. Severe cases of pistachio allergy can result in life-threatening anaphylaxis that is characterized by throat and face swelling, breathing problems, and tightness in the chest area.

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What is an allergy?

An adverse reaction of the immune system to allergens occurring in insect venom, foods, medicines, etc., is referred to as an allergic reaction. Humans are allergic to many different kinds of foods, of which peanuts, eggs, soybeans, milk, shell fish, and tree nuts are the most common. These foods contain certain proteins which are incorrectly identified by the immune system as being harmful for the body and attack them, thereby triggering adverse allergic reactions.

The immune system releases IgE or immunoglobulin E antibodies to protect the body. These antibodies then release some chemicals such as histamines which are instrumental in causing the allergic symptoms. Different people suffer from different forms of allergic reactions with varying levels of severity. A single individual may also elicit varied symptoms during different bouts of allergic reactions.

Pistachio allergy: Cross reactivity

Many individuals with pistachio allergy are not allergic to all kinds of tree nuts. But, due to increased cross-reactivity with other tree nuts some people with pistachio allergy may also be allergic to other tree nuts. The strongest cross-reactivity of pistachio is with cashew, but it can cross-react with other tree nuts as well. Hence, people with pistachio allergy are typically asked to refrain from the intake of all tree nuts.

There is no biological connection between tree nuts and peanuts which are legumes. But tree nuts also have high cross-reactivity with peanuts. Hence, people with pistachio allergy are also advised to avoid peanuts.


Exposure to pistachio can result in varied symptoms in about 2 hours. These signs and symptoms may be mild or severe.

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  • Pistachio allergy can cause abnormal symptoms of the upper respiratory system. Patients may experience watery and itchy eyes as well as sneezing. Some individuals with pistachio allergy may feel itchiness in their throats which triggers coughing or an elevated desire to cough. Other common symptoms include dark circles under the eyes and a runny nose; the former arises due to sinus inflammation.
  • Tingling sensations on the tongue and lips.
  • People with pistachio allergy may also suffer from varied skin reactions. Hives and eczema are the most common skin conditions that occur as part of an allergic reaction to pistachio.
    • Hives are red, itchy, raised welts or bumps that form on the skin. They can change shape, disappear from one area and reappear in the same area in minutes or a few hours. They may also spread to some other area. Hives affect the hands, abdomen, around the mouth area, the back, and other areas of the body. Its number and size are dependent on the intensity of allergic reaction.
    • Also known as atopic dermatitis, eczema is a skin rash characterized by blotchy red skin, skin inflammation, itchiness, and occurrence of tiny elevated lumps which may ooze and scab over. Eczema caused due to pistachio allergy generally occurs behind the knees and on the arms.
    • Pistachio allergy can result in asthmatic symptoms. People who have both asthma and pistachio allergy are more likely to suffer from an increase in asthmatic symptoms after contact with the tree nut.Some of the common asthma symptoms include tightening in the throat and chest, breathing difficulties, breathlessness, coughing, and/or wheezing. Pistachio allergy associated asthma attacks can be debilitating and severely affect the daily life, even the routine ordinary chores.
    • People allergic to pistachio may sometimes experience gastrointestinal abnormalities, including diarrhea, stomach pain, and cramping. Intake of pistachio can lead to nausea and subsequent vomiting of the nuts.
    • Severe allergic reactions to pistachio consumption include swelling of the tongue, lips, and face; dizziness; swelling up of the throat which constricts the airways; and serious breathing problems. In rare cases, affected people may experience anaphylaxis, a dangerous condition that requires emergency medical care. The condition is characterized by symptoms like swelling of the airways, breathing troubles, elevated heart rate, lowering of the blood pressure, abnormal heart rhythms, shock, decreased attention, and loss of consciousness.

Pistachio allergy: Ways of exposure

  • A family history of allergies, including pistachio allergy, as well as allergy-linked disorders like eczema and asthma increases the vulnerability towards developing pistachio allergy.
  • The most common manner in which people with pistachio allergy get exposed to the nut is consumption, i.e., unintentional eating or digestion.
  • Inhalation of pistachio particles can also cause allergic reactions. Cooking can release the nut particles into the air. It can also occur during processing or crushing of nuts in factories that use pistachio as an ingredient in varied food products.
  • There is no empirical evidence to indicate that touching or smelling pistachio can result in allergic reactions. It is rare, but this can also occur.

Treatment of pistachio allergy 

Pistachio allergy has no known cure. Treatment involves managing the symptoms and taking precautions to avoid varied routes of exposure.Mild as well as severe symptoms of pistachio allergy are treated with medications.

  • Minor hives clear on their own without medical treatment. Affected people need to avoid showers and baths as well as the use of irritating apparels so as to alleviate itchiness. Itching and swelling can also be reduced with OTC antihistamines.
  • Application of hypoallergenic creams, anti-itch lotions, and topical antihistamines can help find relief from mild eczema symptoms.
  • Severe reactions can be controlled with topical steroids. People prone to severe cases of pistachio allergy reactions, including anaphylaxis, must carry epinephrine injections with them at all times. Later, visit the doctor for a confirmation checkup.
  • Avoiding all foods that contain pistachio as well as other nuts is the best way to prevent allergic reactions to pistachio or any other kind of nut.
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