Q:

7/5/2013
I recently saw a young woman with known, proven tree nut allergies. She is asking me whether it is safe or not for her to consume alcoholic liqueurs for which tree nuts have been used in their preparation: e.g. Amaretto, Frangelico, Bombay Sapphire Gin etc etc. I am wondering if the procedures/distillation safely eliminate the allergenicity of the nuts?

I did my best to see if there was reliable information but came up with ambiguity and am wondering if you have any data about this.

I did find the following from the Frangelico brand website: "The hazelnuts are infused into a distillate so there are generally no problems for people with nut allergies, however, caution should be exercised."

It appears that the particular brand of Amaretto by Di Saronno does not in fact use almonds, but rather an apricot product, in its preparation.

I found this link to a European source about food safety which seems to suggest that such liqueurs are safe:

Please refer to the last paragraph in the summary. If I understood the paper properly, the "applicant" is the European Spirits Organisation, so, not a disinterested party, and some of the data used to reach the conclusion I refer to were provided by the applicant.

Thanks for any insight you can provide with this question.

A:

Thank you for your inquiry.

First of all, I think you have done an excellent job in looking up the literature in this regard and I can add nothing definitive to the information that you found. In actuality, I think that there is no "carte blanche" answer that would apply to all the distilled liqueurs in question. For example, gin, which is made from agricultural products, usually barley, is available in different flavors. In terms of the gin you specifically mentioned, Bombay Sapphire, the infusion is with a mixture of juniper, lemon peel, grains of paradise, coriander, cubeb berries, orris root, and almonds. On the other hand, Tanqueray London Dry Gin does not have nuts in it. It contains juniper, coriander, angelica, and liquorice. So, there would be no obvious risk in a nut-allergic patient drinking Tanqueray London Dry Gin. The grain itself, of course, presents no significant clinical cross-reactivity with nuts.

Another example of the variation of the contents of each liqueur is that Disaronno Originale Amaretto (as you mentioned), although it has a bittersweet almond taste, does not contain almonds or nuts. It is described as containing apricot kernel oil. In addition, it has 17 selected herbs and fruits. The exact herbs and fruits contained is not listed by the manufacturer, but they do state that this drink is nut-free. Thus, one cannot apply a carte blanche rule to each and every liqueur.

My opinion is that the risk is very small of a patient allergic to nuts reacting to a liqueur which contains the essence of nuts in a well-distilled product. However, unfortunately, the only way that you could know for sure would be to do an oral challenge to the liqueur. We have done oral challenges to alcoholic products previously, and they are not difficult to do; the only caveat of course is that the patient should have a driver to take them home.

In sum, the only way that I know of to answer your patient’s question is to look up, on the website of the dealers, the contents of any liqueur your patient wishes to ingest. If there is no nut product, there would be seem to be no risk of a reaction. If a nut product was contained, she should avoid that product, or alternatively, since I think the risk would be small, you could do an in-office oral challenge to small but gradually increasing amounts.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology