Is it common to be allergic to pistachios?

In the UK roughly 0.5% of the adults and 2% of children have a tree nut allergy. And yes pistachio nut allergy is on that list. While they might be a safe protein-packed snack for most, for others they ‘re fast-track to an allergy reaction ranging from mild to life-threatening.

It’s easy to assume a handful of pistachios is harmless, after all they are heart-healthy, plant based and full of antioxidants. And that is true for many, but pistachios belong  to the same botanical family as cashews and reaction to one often means sensitivity to other. 

In my experience, people don’t realise they are allergic until the break a rash from eating a pistachio ice cream. These reactions aren’t rare and are often overlooked. Even more confusing, some people who are allergic to some nuts can tolerate other nuts.  

Understanding Pistachio Allergies:

How common are pistachio Allergies?

Pistachio allergies fall under the umbrella of three nut allergies, which affect roughly 1.75% of UK population. while that may sound small, it translates to over 1,100,000 (2025).  Children are more frequently diagnosed than adults and unfortunately most don’t outgrow it. 

Pistachios specifically are considered a moderately common allergen. Not as widespread as peanuts (which are legumes, not nuts), but closely related to cashews. In fact, if you are allergic to cashews, there a high chance you’ll react to pistachios too. The proteins are structurally similar, which can trigger a cross-reactive immune response. 

What does a pistachio allergy look like?

Symptoms can vary significantly from person to person. some are subtle. others escalate fast. Here’s what to look for.

Mild to Moderate Symptoms:

• tingling or itching in the mouth
• Hives or skin rash
• Swelling of lips, face or tongue
• Stomach pain, nausea or vomiting

Severe (Anaphylactic) Symptoms:

• Shortness of breath or wheezing
• Throat tightness
• Drop in blood pressure
• Rapid pulse
• Loss of consciousness

If symptoms like these occur within minuets to two hours after eating pistachios (or foods containing them), it is essential to seek immediate medical attention. Severe reaction can be fatal if not treated quickly with epinephrine. 

Whose at risk?

Pistachio allergies are more likely if:

• You have a family history of nut allergies
• You already have a cashew allergy
• You have other atopic conditions like eczema, asthma or hay fever
• You were introduced to nuts later in childhood (early exposure may reduce risk in some cases)

Diagnosing a pistachio allergy

If you suspect allergy, don’t rely on guesswork. Diagnosis is key and is more accessible than you think.

Common diagnostic tools:

• Skin prick test: A small amount of pistachio protein is placed under the skin to check for reaction.
• Blood test: Measures immune response to pistachio proteins.