Download Food Allergies, Nona Navarez, Anaphylaxis and Food Allergy Association of Minnesota (PDF: 815KB/47 pages)

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
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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:
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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:
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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)
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One dose: 10‐20 minutes
 Ambulance and ER visit
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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:
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Listed among other ingredients (e.g. “Ingredients: apples, egg, milk, sugar, cinnamon, cloves”)
or
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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!
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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.”
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…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
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Cleaning ‐ Practices
Cleaning should include  Tables – including sides of table  Counters
 Doorknobs
 Handles  Toys
 etc.
Copyright 2010 AFAA
Summary
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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
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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
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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:
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Soymilk rice milk oats milk multigrain milk potato milk
water
NOT goats’ milk!
Copyright 2010 AFAA
Ingredient Substitutes
For peanut butter:
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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