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Nona Narvaez Executive Director & Founder Anaphylaxis and Food Allergy Association of Minnesota (AFAA) Food Allergies 12 million Americans 200,000 Minnesotans Increased 18% from 1997 to 2007 Copyright 2010 AFAA Some other diseases necessitating dietary restrictions celiac disease gastroesophageal reflux disease (GERD); eosinophilic esophagitis (EE); eosinophilic gastroenteritis (EG); eosinophilic colitis; amino acid, organic acid, and fatty acid metabolic and malabsorption disorders such as cystic fibrosis, phenylketonuria (PKU), maple syrup urine disease (MSUD), and homocystinuria (HCU). Copyright 2010 AFAA Food Allergies are Not: Reactions to MSG or spices Overconsumption of caffeine or other foods Viral or bacterial infections Enzyme deficiencies (e.g. lactose intolerance) Celiac disease Metabolic disorders Copyright 2010 AFAA Food Allergies are: An Immune reaction Copyright 2010 AFAA Allergic Reactions Any of the following ‐ alone or in combination: Digestive Upset Hives (only 50% of the time) or eczema Swelling Breathing Difficulty Blood Pressure Drop Death Copyright 2010 AFAA Allergic Reactions Any of the following ‐ alone or in combination: Digestive Upset Hives (only 50% of the time) or eczema Swelling Breathing Difficulty Blood Pressure Drop Death Copyright 2010 AFAA Allergic Reactions Severe allergic reactions are called: Anaphylaxis Copyright 2010 AFAA Triggers of Anaphylaxis Medications Foods Insect bites (bees, wasps, etc.) Exercise Idiopathic Copyright 2010 AFAA Allergic Reactions Avoiding allergens only strategy for avoiding reactions! Reactions Need to be treated promptly! Have a Plan! Who will administer medication? Who calls 911? On which telephone? What will be said when calling 911? Epinephrine autoinjectors (brands: EpiPen,Twinject, Adrenaclick) One dose: 10‐20 minutes Ambulance and ER visit Medical observation for 4 hours in case of biphasic reaction Antihistamine per M.D.’s orders Copyright 2010 AFAA Triggers of Food Anaphylaxis Ingestion Inhalation Tactile It can be difficult to distinguish an external reaction from an anaphylactic reaction. Don’t take chances ‐ treat for a severe reaction! Copyright 2010 AFAA Common Allergens in the U.S. Milk, Egg Peanuts, Treenuts Fish, Shellfish Wheat, Soy These “8 Major Allergens” account for 90% of reactions Copyright 2010 AFAA Common Allergens in the U.S. Milk, Egg Peanuts, Treenuts (including, but not limited to: almond, Brazil nut, cashew, chestnut, filbert/hazelnut, ginkgo biloba, lychee, macadamia nut, mongongo, pecan, pine nut, pistachio, walnut…) Fish, Shellfish (finned fish such as tuna, cod, salmon, catfish; crustacean and mollusks) Wheat, Soy Copyright 2010 AFAA In other Countries Common allergens are: Sesame (Netherlands, United Kingdom, Canada) Sulfites (Canada) pip and stone fruits, such as apple, peach (Germany) vegetables such as celery, carrot Kiwi, mustard, and sunflower are increasingly common Copyright 2010 AFAA Multiplier Effect… Dietary restrictions affect food purchases and dining Copyright 2010 AFAA Key Message Food Allergies are Challenging…but Manageable Control the Allergens Copyright 2010 AFAA Food Labels – 2004 Law 8 Major allergens must be listed in one of two ways: Listed among other ingredients (e.g. “Ingredients: apples, egg, milk, sugar, cinnamon, cloves”) or Listed separately (e.g. “Contains: wheat, soy”) USDA products not included in law (only FDA products) Copyright 2010 AFAA Food Labels – Confusing Words: Confusing Labels “May contain" labels “processed on equipment that processes a, b, c” “processed in a plant that also processes x, y, z” More than 30 variations of allergen statements! If is has no allergen statement, is it safe? Copyright 2010 AFAA If milk allergic: don’t be misled... "non‐dairy“ kosher designations Product may still contain milk protein! Copyright 2010 AFAA Ingredient Substitutes – Careful! Margarine usually contains whey (milk protein) Organic cold‐pressed olive oil may contain treenut allergens Items with treenuts may contain peanut allergens Treenuts are often processed together Fish and shellfish may be cross contaminated Spelt contains wheat allergen Egg allergen may be in non‐egg pasta, or on bread products, or even candy Soy lecithin is safe for most people, but not all Soy cheeses may contain milk protein Copyright 2010 AFAA Etcetera etcetera Always investigate! Food Labels – Read them! All processed items subject to ingredient changes – check labels every time! When in doubt, call the company! (Even better – get information in writing.) Copyright 2010 AFAA The Hazards to Customers A customer wishing to dine in a restaurant or eat a product not labeled under the Food Allergen Labeling and Consumer Protection Act (FALCPA) faces challenges in regard to the safety of the food they wish to eat: Communication with and between employees Eliciting ingredient information Cross‐contact with allergens Copyright 2010 AFAA Customer Responsibility – Communication of Needs! If a customer withholds information from employees regarding their dietary restrictions, the food service establishment cannot accommodate their needs, and the customer increases their risk of allergen exposure! Copyright 2010 AFAA Communication between employees If an employee does not communicate information conveyed by the customer to: the person‐in‐charge food preparers necessary colleagues Allergens may inadvertently end up in the food! Copyright 2010 AFAA Communication between employees If an employee does not communicate information conveyed by the customer to: the person‐in‐charge food preparers necessary colleagues Allergens may inadvertently end up in the food! Copyright 2010 AFAA Communication to Customer If employees do not communicate risks and/or precautions the establishment plans to take for the customer… Copyright 2010 AFAA Communication to Customer If employees do not communicate risks and/or precautions the establishment plans to take for the customer, the customer cannot make an informed decision about eating the food being served to him/her and… Copyright 2010 AFAA Communication to Customer If employees do not communicate risks and/or precautions the establishment plans to take for the customer, the customer cannot make an informed decision about eating the food being served to him/her and decide whether they are willing to accept the consequences of eating the food. Copyright 2010 AFAA Communication to Customer Perhaps the most important statement possible: “I don’t know.” …if it has unsafe ingredients …its source …if cross‐contamination is an issue …if I can find reliable answers…. Copyright 2010 AFAA Creating a system to manage food allergies (from the CIA) A Sample Flow Chart: 1. Customer says "I'm allergic to any kind of fish or shellfish." 2. Serving staff notifies manager. 3. Manager talks with diner about his or her special needs. 4. Manager consults with chef 5. Chef checks ingredients 6. Chef communicates the need for added precautions to kitchen staff 7. Kitchen staff prepares the meal 8. Manager, server or chef hand‐carries the plate separately to the table 9. Server confirms that the dish has been specially prepared to accommodate the diner's food allergies. 10. Server checks with diner immediately to make sure the meal is satisfactory. Copyright 2010 AFAA Avoiding Cross Contamination Be Smart: Keep Foods Apart! Copyright 2010 AFAA Keep Foods Apart! 2007 Food Service Employee Study* 24% 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 *Food allergy management from the perspective of restaurant and food establishment personnel, Annals of Allergy, Asthma & Immunology, Volume 98, Issue 4, Pages 344‐348 R. Ahuja, S. Sicherer Copyright 2010 AFAA Avoiding Cross Contamination Watch for inadvertent cross contamination Dirty hot mitts or aprons Crumbs from employee snacks and meals Unwashed hands Poorly washed utensils Dirty storing areas Unprepared prep surfaces Risky storage practices Copyright 2010 AFAA Avoiding Cross Contamination Pre‐clean preparation areas Dedicate work areas. Don’t reuse sheet liners, aluminum foil, plastic wrap, etc. Use separate utensils or equipment when possible. Prepare allergen‐safe food first. Copyright 2010 AFAA Cleaning‐ Supplies Cleaner Cloth, sponges, paper towels Properly store clean items Soaps & lotions Copyright 2010 AFAA Cleaning ‐ Practices Cleaning should include Tables – including sides of table Counters Doorknobs Handles Toys etc. Copyright 2010 AFAA Summary Food allergy reactions can be very serious >140 foods have caused reactions Label reading can be confusing Call manufacturers for complete information Communication essential: customer, employees, person‐in‐charge Avoid cross‐contact/cross‐contamination: Unwashed hands/gloves/mitts/counters etc.; storage; utensils & equipment already in use; cooking practices Establish good cleaning protocols Copyright 2010 AFAA Key Message Food Allergies are Challenging…but Manageable Control the Allergens Copyright 2010 AFAA AFAA Resources Trained Speakers & In‐Service Training Fliers Autoinjector Trainers & training DVDs Support Meetings, E‐mails, & E‐Magazine Restaurant Poster! (request pdf. version at [email protected]) www.minnesotafoodallergy.org AFAA ‐"Taking the Fear Out of Food Allergies!" Copyright 2010 AFAA AFAA Events Camp for food allergic kids (June 11‐13) Peanut‐free Twins Baseball Games (various dates) 4th of July Parade Marching Minnesota State Fair Booth – volunteer for free Fair admission! Conference & Expo ‐ U of M (November 6, 2010) Copyright 2010 AFAA Concert/Silent Auction AFAA Anaphylaxis & Food Allergy Association of Minnesota Taking the Fear Out of Food Allergies! 501(c)3 non‐profit Volunteer‐run 2200 Hendon Avenue; St. Paul, MN 55108 (651) 644‐5937 [email protected] www.minnesotafoodallergy.org Copyright 2010 AFAA Copyright 2010 AFAA Ingredient Substitutes For Milk: Soymilk rice milk oats milk multigrain milk potato milk water NOT goats’ milk! Copyright 2010 AFAA Ingredient Substitutes For peanut butter: Sunbutter (sunflower seed) Soybutter Peabutter (yellow lentils) Almond butter Cashew butter Copyright 2010 AFAA Frequency Milk and egg allergy common among babies and toddlers usually outgrown by age 5 Shellfish most common adult food allergy Usually develops in adulthood Peanut allergy most commonly known by public Other allergies can be just as serious! approximately 20% outgrow peanut allergy Copyright 2010 AFAA How? Why? Exposure (sensitization) is necessary to develop allergy eating food babies mouthing toys or objects exposure through breastmilk pregnant mom’s diet? Copyright 2010 AFAA How? Why? Exposure (sensitization) is necessary to develop allergy eating food babies mouthing toys or objects exposure through breastmilk pregnant mom’s diet? NO! Copyright 2010 AFAA