A night out at the bars is one of the most popular ways to unwind, but can quickly turn into a trip to the hospital for those with severe allergies. Even people with mild reactions to common allergens such as legumes or nuts are required to practice caution when ordering their drinks, as a number of liqueurs, beers, bar syrups, and more contain unexpected ingredients which can lead to uncomfortable, and even dangerous, reactions.

I’ve learned this the hard way as a spirits and travel writer who recently developed an almond allergy. Though unfortunate, Dr. Reenal Patel, an allergist, tells me that it’s far from uncommon. In fact, the number of those with common allergies is only growing, with the C.D.C. reporting that the number of children with food allergies grew a whopping 50 percent between 1997 and 2011.

“Milk, eggs, peanuts; they tend to be the allergens that we see early on in childhood, but things like tree nuts and shellfish tend to be one of those allergens that we develop later on in life,” Patel says. “Around 1 to 2 percent of the population in the U.S. has a peanut allergy, and roughly one-half to 1 percent have tree nut allergies. Your typical tree nuts, or almonds, walnuts, pecans, cashews, pistachios, Brazil nuts — we tend to see those allergies in childhood too, but they can develop later on in life.”

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Whether you’ve been dealing with a nut allergy for most of your life, or it’s brand new to you, Patel recommends seeing an allergist regularly, and making a practice out of always exercising the utmost caution when dining and drinking, especially considering that those who are allergic to one type of nut could most likely have a sensitivity to an adjacent allergen.

“The cashew is closely related to the pistachio, and walnuts are closely related to pecans, so for instance, if you are allergic to cashews, more than likely you’ll also be allergic to pistachios,” Patel says. “If you’re allergic to walnuts, you’re more than likely going to be allergic to pecans.”

Even for those with mild allergies, Patel says it never hurts to bring your EpiPen along, and urges those with allergies to call the bar ahead of time to ask about potential triggers that can be found on its menu.

It also doesn’t hurt to familiarize yourself with the typical nut allergy triggers you may encounter at any cocktail bar, especially as unique and lesser-known ingredients are quickly making their way onto more menus. Cocktail culture is thriving, and arming yourself with knowledge of what could potentially make you sick will ensure that you keep thriving as well.

Drinks to Avoid With a Nut Allergy

Nuts and nut products are used in a surprising number of cocktail ingredients — most of which are not explicitly labeled as such. In particular, tiki and tropical bars are a hotbed of nut-related allergens thanks to the common use of orgeat and falernum, which are syrups used to sweeten a variety of popular tiki drinks that typically include nuts like almonds. Orgeat is particularly dangerous for those with an almond allergy because, unlike distilled spirits, the amount of nut present in the syrup is extremely high.

Be on the lookout for a number of liqueurs that contain nuts. Those with almond allergies should avoid Amaretto, Amadeus, and Galliano, while people sensitive to hazelnuts should stay away from crème de noix, Frangelico, and Nocello. Crème de noix and Nocino also contain walnuts, while Kahlua’s Original Mudslide and other ready-to-drink options often contain tree nuts.

Tons of beers contain traces of nuts as well, especially those that are marketed for the holiday season and colder months in general. Most of these will be fairly easy to spot, with self-identifying labels such as Ferguson Brewing Company’s Pecan Brown Ale, Phillips Brewing’s Dirty Squirrel Hazelnut Brown, or Hop Butcher For The World’s Milkstachio Pistachio Milk Stout. Watch out for peanut or peanut butter beers in particular, which have been rising in popularity and can sometimes go by less distinctive names, such as Duclaw’s Sweet Baby Jesus! peanut butter porter or Witch’s Hat Brewing Co.’s Bourbon Barrel Traxxx Night Fury, an imperial stout aged with peanut butter, vanilla beans, cocoa, and coconut.

Another sneaky place where nuts make an appearance is in gin, which gets its distinct flavor from juniper and a unique selection of other botanicals, two of which can be bitter or sweet almond. Popular gins such as Beefeater and Bombay Sapphire use almonds in their mixes of botanicals. Luckily, what triggers an almond reaction is the proteins and peptides found within the nut, and those generally do not carry over through the process of distillation. Those with extremely severe allergies should still proceed with caution, though.

What’s OK to Drink With a Nut Allergy

Just to make things even more confusing, there are some “nut-flavored” liqueurs that actually contain no nuts, and are therefore safe for those with allergies. One example is Disaronno, a popular almond-flavored liqueur that gets its flavor from chemical compound benzaldehyde, which in this case is sourced from apricot kernel oil. Also safe are drinks made with creamy or rich liqueurs such as Disaronno Velvet, Baileys, Kahlúa, and Amarula.

Speaking of cream, look out for drinks at the bar that sound milky or creamy, including milk punch and milk-washed cocktails. Make sure to ask whether they use a milk alternative like almond, macadamia, or cashew milk, which are all growing in popularity. As mixologists gain a wider awareness of allergies, oat milk has also been used more frequently and is safe for those with nut allergies to consume.

One ingredient to be on the lookout for, but not necessarily stay away from, is the maraschino cherry. Traditionally, these sweet and syrupy cherries were flavored with bitter almond, but their flavor today usually comes from apricot kernels, similar to Disaronno. Many homemade varieties of maraschino cherries are flavored with almond extract, which, contrary to its name, usually does not contain any almonds.