[CASES OF ANAPHYLAXIS AND IMMEDIATE-TYPE ALLERGIC REACTIONS TO NUTS THAT COULD NOT BE PREVENTED BY MERE AWARENESS OF...

Allergies to walnuts and cashew nuts are on the rise, and walnuts have been required to be labeled as a specific ingredient since March 2023, and labeling requirements are exempt for face-to-face sales. It is expected that the mandatory labeling of cashew nuts will be implemented within the fiscal year 2025. Here, we report two cases in which patients developed anaphylaxis despite heeding cautions regarding the mixing of nuts. Case 1: A child with apprehension about a walnut allergy developed symptoms of anaphylaxis after purchasing and consuming a "peanut cream bread" directly from a store. At a later date, an inquiry with the store revealed that the cream had been mixed with walnut paste. Case 2: A child with a history of anaphylaxis due to cashew nuts experienced symptoms of anaphylaxis after consuming curry bread bought directly from a store, although the child had inquired about the use of cashew nuts and had been reassured that it was all right. At a later date, an inquiry made to the distributor's headquarters revealed that the product did indeed contain cashew nuts. For children with nut allergies, it is important to not only instruct them to check the ingredient labels and store counters but also provide more specific guidance about foodstuffs that may possibly contain such allergens.