Understanding Food Allergies

1. Understanding Food Allergies As they apply to the food service industry.

2. Stats and Facts • Increase in food allergies of 55% in the past 5 years. • 11 million Americans suffer from food allergy, with • 6.5 million allergic to seafood and • 3 million allergic to peanut and tree nuts. • Food allergy reactions result in over 30,000 emergency room admissions each year. • It is estimated that between 150 and 200 people die annually from anaphylaxis to food. Many of these are young children and young adults. • Approximately 2 million school-aged children have food allergy. • One in every 20 children under the age of 3 has food allergies. • Trace amounts of the food allergen can cause a reaction. • Most individuals who have had a reaction ate a food they thought was safe. • Studies have shown that early administration of epinephrine (adrenaline), is key to a patient’s survival of anaphylactic shock.

3. Top 8 • Peanut • Tree Nut • Milk • Egg • Soy • Fish • Shellfish • Wheat

4. Understanding Food Allergies An over-reaction of the immune system which recognizes a specific food protein as a harmful target. Release of histamines which trigger inflammatory reactions in the tissues of the body: Mouth (Itching/swelling) Skin (Hives) Respiratory (Wheezing/coughing) Gastrointestinal (Vomiting, diarrhea) Cardiovascular (Decreased blood pressure, heartbeat irregularities Widespread symptoms are classified as “anaphylaxis” ? What is a food allergy? ? ? ? ? ? ?

5. Understanding Food Allergies What is anaphylaxis? Anaphylaxis is a sudden, severe, potentially fatal, systemic allergic reaction that involves various parts of the body (skin, respiratory tract, gastrointestinal tract and cardiovascular systems). It can occur within minutes up to hours after contact.

6. Food Allergy vs. Intolerance Allergy • Involves the immune system • Antibody production against “foreign” protein • Histamine response that may affect skin and respiratory, gastrointestinal, and/or cardiovascular systems Intolerance • Does not involve immune system (non-IgE-mediated) • Some types can be treated Lactose intolerance – lactase enzyme tablets • Small amounts of food may be tolerated

7. Is there a cure for Food Allergies? Since no cure currently exists for food allergies… NO! STRICT AVOIDANCE is the only way to prevent a reaction.

8. Key Hurdles to Food Allergy Safety 3 Key Hurdles to Food Allergy Safety Insufficient Communication Misinterpreting Ingredient Labels Cross- Contamination

9. Insufficient Communication Communication among several key individuals is necessary to maximize safety and minimize risk.

10. Understanding Ingredient Labels What is FALCPA? Food Allergen Labeling and Consumer Protection Act Created in 2004 to assist consumers in identifying food allergen ingredients • Requires the top 8 allergens be written in plain English when the major food allergen is not listed as part of the • ingredient list: • After the list, such as “contains milk” • Within the list, such as “albumin (egg)”

11. Understanding Ingredient Labels Limitations of FALCPA Applies only to the top 8 “major food allergens” Does not apply to meat, poultry, eggs, fresh fruit, alcoholic beverages, cosmetics, sundries, or pharmaceuticals Does not pertain to refined oils Does not establish standards for the use of “may contain” or advisory statements for shared equipment in food processing

12. Cautionary/advisory statements used by manufacturers as protection. Ignored by consumers due to the perception of limited product options. Overused Voluntary Greater than 30 different variations in which warnings are phrased (FAAN) No thresholds exist to define an “ingredient” and levels for advisory warning statements Use of advisory statements are determined by the manufacturer The choice to recall a product is determined by the manufacturer Inconsistent Risk Potential for cross-contamination with allergens in processing Misconceptions Incorrect interpretation of one advisory statement phrase as safer than another Understanding Ingredient Labels

13. Almost ½ of consumers with food allergies have serious problems using food labels to help them avoid certain foods. (FDA) This is because: Ingredient lists continue to use general names (spices/natural flavors) without specifying the source Different words are used to describe an allergen on different food products There are inconsistencies in the use of bold font Food labels do not alert consumers when new ingredients are added or ingredients change The length of the ingredient list often makes it difficult to find the ingredients of concern Understanding Ingredient Labels

14. The FDA is developing a long-term strategy on advisory labeling that is: Understanding Ingredient Labels • “Truthful and not misleading” • “Conveys a clear and uniform message” • “Informs the food allergic consumer”

15. What do I need to know when reading ingredient labels? Read the label EVERY time! Look for the phrases such as the following: “May Contain:” (listed w/in ingredient list or under list) “Product may contain traces of…” “Produced/Manufactured on shared equipment with…” Avoid any product with the allergen(s) of concern listed in any of these phrases! Call the Manufacturer with questions!

16. Types of Cross Contamination Hand to Food Food to Food Equipment or Surface to Food

17. Understanding Cross Contamination Occurs when a food free of allergens inadvertently comes into contact with an allergen Can occur in any number of areas: Kitchen: Preparation Cooking Serving Cleaning Storage Surfaces: Counters Tables Chairs • ANY surface, if not properly cleaned, has the potential for cross contamination!

18. Proper Cleaning Methods Without appropriate cleaning, surfaces and hands become a source of cross-contamination. Proper Cleaning Methods: Surfaces • Common household cleaning agents with a clean towel and water. Hands • Soap and Water or Commercial Wipes • Not Anti-Bacterial Sanitizer or Water Alone

19. Dangerous Misconceptions 24% of food service personnel believed that consuming small amounts of an allergen is safe 35% believed that fryer heat destroys allergens 25% believed it was safe to remove an allergen such as shellfish or nuts from a finished meal 54% of restaurant personnel think a buffet is safe if kept clean 70% of those with food allergies tell the restaurant staff all the time, 20% usually, and 6% sometimes.

20. Hidden Allergens • Things we eat are not the only sources of food allergens. • Anything that has ingredients is a potential risk and needs to be checked. • Cleaning products • Soaps and lotions

21. Understanding Anaphylaxis Watch! An anaphylactic reaction can occur immediately or up to 2 hours following exposure to allergen Some do not involve signs such as hives Be Prepared! Every food allergy reaction has the potential of developing into an anaphylactic reaction Treat Immediately! Immediate administration of epinephrine followed by prompt request for emergency medical services is critical

22. Recognizing a Reaction • Three important reminders: • Medical research emphasizes that early recognition of symptoms saves lives. • Allergic reactions are unpredictable: they may present and progress differently than previous reactions AND a seemingly mild reaction can turn serious very quickly. • A person experiencing anaphylaxis may show no skin symptoms –no hives, no rash, no swelling

23. Recognizing a Reaction Symptoms may include one or more of the following: Mouth • Itchy, tingling, or swelling of lips/tongue Nose • Hay fever-like symptoms: runny, itchy nose; sneezing; and/or watery, red eyes Skin • Hives, rash, redness, itching • Flushing (redness & warmth) • Swelling of face or extremities Gut • Cramps/pain • Nausea, Vomiting, Diarrhea Throat • Hoarseness • Tightening of throat/difficulty swallowing • Hacking cough Lungs • Shortness of breath, wheezing • Repetitive, hacking cough Heart • Low blood pressure, weak pulse • Pale, blue color • Dizzy, fainting Other/Mental • Anxiety, “sense of impending doom”

24. What can you do? • Be honest! • Know your ingredients, and provide ingredient information when asked. • Maintain contact information for manufacturers/vendors. • Train your staff. • Ensure proper cleaning of work areas and utensils or consider dedicated work areas or utensils.