Nutritional Consequences of Cross Contamination

1. Nutritional Consequences of Cross Contamination A professional & personal perspective Deborah Griffin MINDI Senior Paediatric Dietician

2. Almost anything can be an allergen to someone.

3. Cross contamination from farm to fork Processing Aids Raw Material Storage Air Particles in Manufacturing Area Cross contamination Equipment Carelessness Cleaning Chain Supply Packaging People Handling

4. So what foods......... Adults (1-2%) • shrimp, lobster, crab, and other shellfish • peanuts and other tree nuts • fish • eggs Children (6-8%) • Cow’s milk • Hen’s egg • Soy Bean • Peanut • Tree nut • Fish • Crustaceans

5. IgE dependent – Acute onset

6. IgE-associated/cell mediated/delayed onset/chronic

7. Cell mediated/delayed onset/Chronic

8. EU Guidelines – Common Allergens • Cereals containing gluten • Crustaceans • Egg • Fish • Peanuts • Milk • Nuts (Hazel nut, brazil nut, almond, walnut, cashew, pecan, pistachio and macadamia) • Soya • Sesame • Celery • Mustard • Sulphur Dioxide/Sulphites Directive 2003/89/EC

9. Consequences of cross contamination Discomfort – nausea, vomiting, pallor, pain, diarrhoea, asthma, mal-absorption, oedema, nutrient deficiency, poor growth, weight loss, tiredness,anaphylaxis..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................DEATH

10. Nutritional Consequences • Nausea and vomiting – decreased dietary intake • Malabsorption - diarrhoea • Omitting food groups – missing nutrients • Poor growth • Nutrition related diseases – anaemia, osteoporosis etc. • Self restricted eating habits

11. Baby Sean • Bottle fed baby – known milk allergic – on prescription milk free formula • Mother out shopping – asks for baby bowl with no butter in potatoes • Baby bowl contains – potato, carrots and gravy • Baby starts spitting out after a few mouthfuls and becomes unsettled. Rash develops on face. • What’s to blame?

12. Alice – Known prawn allergy • Out with friends for a meal in a Chinese restaurant • Restaurant informed of allergy • Variety of starters ordered – no prawn’s??? • Within minutes of eating – Alice unwell and having difficulty breathing – administered Adrenaline pen – ambulance to hospital • Where was the problem? Chef cooked Alice’s starter separately........

13. Teenage Tom • Known nut allergic since childhood • Started secondary school • Friday lunch out – chipper/deli • Roll this occasion – ham, cheese, coleslaw • Immediate swelling of lips – difficulty breathing • Rushed to hospital • Cause of reaction???

14. CASPER

15. Casper the friendly ghost......... • 3 month history of excessive tiredness • Bone and muscle pain • 6 week history of nausea and stomach pain • Made worse by morning scones................ • Got to know every bathroom in the hospital • Self restricting diet with a few months – gone off bread, pasta, cereals.............. • Einstein moment – COELIAC DISEASE (had to convince the GP!!!!)

16. Diagnosis on bloods and biopsy. • Immediate gluten free diet (STRICT) • Packed lunches and breakfast before work! • Feeling better after 1 month – no nausea and stomach pain • Friends birthday – decided to brave eating out • Informed restaurant on booking – informed waitress on arrival

17. Played safe – ordered tomato and mozzarella starter and steak (garlic stuffed, wrapped in bacon) and salad main, latte rather than dessert. • Beautifully presented meal, 20 minutes later – stomach cramps and nausea........................ • The cause wasn’t the wine!!! • Any idea’s??

18. Gluten free • Intolerance to gluten found in wheat, barely and rye. • Proteins to blame Gluten, Hordein and Secalin. • Coeliac disease is NOT an allergy! • Due to cross contamination oats not advised, also some individuals sensitive to Avenin. • Natural gluten free foods. • Gluten free foods – Codex Standard • Changes to codex

20. Active coeliac disease • Impairs absorption of nutrients in the upper small intestine • Mainly iron, folate and calcium • Ongoing inflammation and damage in the intestine lining increases the need for tissue repair and increasing the risk of several cancers of the intestine

21. Short term consequences • Generally uncomfortable for patient • Pain, nausea, vomiting, diarrhoea • Just because it doesn’t cause an issue when eaten – doesn’t mean it is not causing damage!!

22. Long term consequences • Mal-absorption • Nutrient deficiency • Poor Growth • Ill health • Gluten sensitivity in other organs e.g. skin – dermatitis herpetiformis and rarely the nervous system – gluten ataxia • Death – cancer

23. Individuals educated on what to look for on a label. • Issue with eating out mainly hence many people restrict eating outside of home – restaurants and deli’s. • Staff education on ingredients, storage, preparation, cooking, serving! More importantly identification of probable and remote causes of cross contamination. Management plan. • Language issues – foreign staff.

25. On being a crumb grouch • Living with a food allergy/intolerance impacts dramatically on life. • Once advised easy to achieve in the home. • Difficult when out for a variety of reasons...... • Not just asking about ingredients to be a pain!! • Impact real – and not enjoyable. • For those with anaphylactic allergy – life threatening.

26. You don’t need to eat it........... Latex gloves Dinners on me! Food packaging Washing up /cleaning solutions

27. Any questions?