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Q:

Reviewed: February 24, 2020
7/31/2015  
Is amaretto liqueur made from almonds or apricot pits an allergen. Should the source of the flavorings (almonds or apricot pits) be listed in the ingredient statement? The actual bottle of the amaretto liqueur does.

A:

Amaretto can be made with a variety of materials and at least one product, Disarno originale, states that it contains no almonds and is nut free. Apricots and almonds are technically not nuts but are seeds from stones or pits of a drupe, a fleshy fruit surrounding the stone or pit. Many of the culinary nuts are technically drupe seeds; for example, cashew, hickory, walnut, pecan. Apricots does cross react with almonds along with peaches which are in the Rosaceae family. All of these may cross react with birch pollen. The extract from apricot pits does have an almond flavor.

The amount of glycoproteins in the amaretto final product is likely to be diminishingly small such that even if prepared with an almond extract most likely a food allergic person would tolerate. The only way to be sure would be to challenge the person with the amaretto while under close observation if there is reason to suspect an allergic reaction. I would not feel this is necessary in an individual with almond allergy who has never reacted to amaretto. In the case of almond allergy, one could choose a product such as Disarna orginale which contains no almond. Apricot allergy related to eating the fruit is increasing in prevalence (Pastorello) but is not relevant to reactions from the seed extract used in Amaretto.

I have copied a question from the archives of Ask the Expert that you may find of value.

I have shared this response with Dr. Scott Sicherer, professor of pediatrics at the Jaffe Food Allergy Institute and the Icahn School of Medicine at Mount Sinai, to see if he as other thoughts. Scott authored a book entitled Food Allergies: A Complete Guide for Eating When Your Life Depends on It (Johns Hopkins Press). You may find this a useful resource.

Dr. Sicherer has responded.
"I did review the response and I think I have the familiarity to comment. I also ran this by our dietitian, Marion Groetch, who is expert in food allergy issues. Her points include: it may be worth mentioning alcoholic beverages are exempt from FALCPA (the 2006 food allergen labelling and consumer protection act). In other words, they do not have to label milk, egg, tree nuts, etc. Also, in alcoholic products, if the flavoring is infused prior to distilling there is virtually no risk but if it is infused after distilling that could be different. As an example, all distilled beverages are considered gluten free even if the source was a gluten-containing grain such as rye, as the proteins are too large to distill (as per Steve Taylor in a previous communication and the CD literature).

The lipid transfer protein (LTP) allergy in the Patorello paper is a hypersensitivity to a stable protein that (particularly in Spain) is related to systemic reactions; but most oral allergy to Rosaceae family fruits are caused by Bet v 1 birch homologues that are digested easily or destroyed with heating/processing and relate only to mild oral symptoms. On the other hand, anaphylaxis to beer (rare) has been traced sometimes to LTP from base food components. The pit, as you probably know, is not typically eaten straight in our country as it also has a cyanide issue, and potential allergens in the pit have not been discussed in the literature to my knowledge."

In summary, as pointed out by Dr. Sicherer, alcoholic products are not subject to the Food Allergen Label and Protection Act and therefore manufacturers are not required to list component ingredients. Also, the production of alcohol makes the importance of ingredients difficult to interpret since the timing of the use of the ingredient is critical, for example before or after distillation, and extracts of seeds may have no relevance to fruit allergy. Amaretto generally contains an extract from either almond or apricot seeds but the timing of the addition of the extract would affect any theoretical allergy risk. The likelihood of an allergic patient reacting to amaretto is very remote but only a challenge would verify the lack of an adverse effect.

1. Orebrand, Ulrika. "Detection and quantification of almond (Prunus dulcis) in food with ELISA." (2006).
2. Pastorello, Elide A., et al. "Allergenic cross-reactivity among peach, apricot, plum, and cherry in patients with oral allergy syndrome: an in vivo and in vitro study." Journal of Allergy and Clinical Immunology 94.4 (1994): 699-707
3. Pastorello, Elide A., et al. "Evidence for a lipid transfer protein as the major allergen of apricot." Journal of Allergy and Clinical Immunology 105.2 (2000): 371-377.

Is it safe for people allergic to nuts to drink distilled liqueur which may contain flavoring from nuts?
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. 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.

A: 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.

Sincerely,
Phil Lieberman, M.D.

I hope this information is of help to you in your practice.

All my best.
Dennis K. Ledford, MD, FAAAAI
 

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