Serving Up Allergy Free

Transcription

1 Sponsor Disclosure: Support for this presentation was provided by the Foodservice Express division of Med-Diet, Inc. The material herein is for educational purposes only. Reproduction or distribution of these materials is prohibited except as expressly provided by Med-Diet, Inc. or the presenter. Copyright 2013 Med-Diet, Inc. All rights reserved. 1 Serving Up Allergy Free A Focus On Food Allergies and Intolerances 1

2 Program Objectives Review major food allergies and intolerances and their respective dietary implications Discuss navigating food labeling and identifying hidden allergenic ingredients Provide ideas for an allergy-friendly food prep & service Did you know? Any food can cause an allergic reaction. Corn, gelatin, grapes, onion, tomato, banana, apple Stone fruits: plum, peach, nectarine, cherries Meats: beef, chicken, mutton, pork, Seeds: sesame, sunflower, poppy Spices: caraway, coriander, garlic, mustard Different countries have different top allergens People can have many different types of allergies besides foods. Sometimes leading to cross-reactions 2

3 Prevalence Clinically diagnosed Food Allergy 5% of children 4% of adults Food Intolerance / Sensitivity Not quantifiable 1:3 people claim issues Definition - Allergy Abnormal response to a normal food Triggered by immune system Body produces antibody IgE Reaction may be immediate to hours after exposure Response ranges from mild to severe Risk is tied to genetics Proteins in the offending food have survived usual breakdown from cooking, stomach acids and/or digestive enzymes 3

4 Allergic Response Response & timing unique to individual Protein fragments are introduced and allergic reactions follow Itching in mouth as food is eaten Abdominal discomfort with digestion Vomiting, diarrhea, GI pain Allergens in bloodstream Drop in blood pressure Upon reaching the skin hives, eczema Reaching the lungs wheezing Oral Allergy syndrome Allergy to pollen creates an issue with raw fruits/vegetables Localized to mouth /oral cavity / throat Cooked item is tolerated 4

5 Definition - Intolerance Intolerance / Hypersensitivity - Not a true allergy Non-IgE mediated Abnormal physiological response to food or food compound Not tied to genetics Varied mechanisms of action: Metabolic: absence of chemicals/enzymes to digest a food Lactose, fructose intolerance GI: Inability to absorb nutrients Fructose malabsorption Pharmacologic: natural/artificial food chemical sensitivity Salicylate, sulphites, nitrate Intolerance/Sensitivity Response Chronic vs. acute, less obvious Dose / exposure dependent Symptoms vary greatly Skin: rash, hives, dermatitis, eczema Respiratory: nasal congestion, sinusitis, throat irritation, asthma, cough GI: mouth ulcers, cramping, nausea, gas, diarrhea, IBS Anaphylaxis 5

6 Top 8 Food Allergies Milk Peanuts Eggs Tree Nuts Wheat Shellfish Soybeans Fish 11 Egg Allergy 6 billion eggs produced/distributed monthly Affects 0.2% (600,000) Americans 70% outgrow allergy by age 16 Most common reaction is skin related Often as eczema in infants / younger children Food sources: egg, egg dishes, baked goods Hidden sources: canned soups, salad dressings, ice cream, mixed meal dishes (meatloaf) 6

7 Egg Allergy White or Yolk? Allergy may be to either but neither should be eaten Eggs in mixed foods (baked goods) Reaction not predictable Baking substitution: 1 Egg = 1 ½ Tbsp water + 1 ½ Tbsp oil + 1 tsp baking powder OR 1 Egg = 1 tsp yeast dissolved in ¼ cup warm water Maximum recipe replacement is for 1-3 eggs Fish Allergy 20,000+ species of fish Avoid them all (unless allergist advises otherwise) Affects 0.4% of population More women than men Often develops in adulthood Children not excluded Reactions range BUT anaphylaxis is common Food sources: fish and fish dishes Hidden sources: Worcestershire sauce, Caesar salad, surimi (imitation crab), fish stock, Asian cuisine 7

8 Fish Allergy Fish vs. Shellfish Usually not connected May be advised to avoid both Challenge Cross contamination Mislabeling Milk Allergy Common allergy in children IgE mediated Non IgE mediated Affects 300,000 children under 3 yrs 80% outgrow allergy by16 yrs Common reactions Blood in stool, vomiting, hives Food sources: milk and milk products Hidden sources: casein, whey 8

9 Milk Allergy ~75% of those with allergy can tolerate some milk containing foods Milk has been extensively heated (e.g. baked goods) Milk allergy versus lactose intolerance Not related Allergic reaction is to the protein and will be more severe Intolerance is not tied to milk protein but the sugar lactose Lack enzyme lactase to digest the milk sugar People with intolerance Small dose of milk products okay Especially in context of mixed meal Peanut Allergy Not a nut! Affects 400,000 children Incidence has tripled from ~20% outgrow allergy Associated with severe reactions Unpredictable Epi pen usually needed Sources: baked goods, ice cream toppings, cuisines (Asian, Mexican), candies Hidden sources: cross contamination 9

10 Peanut allergy How close is too close? Cases have been reported resulting from nearness and smell BUT Blind, placebo controlled trial of children showed no systemic reaction Peanut protein could become airborne (via grinding) Response usually not anaphylactic Smell triggers something physiologic Rash, BP Most can consume peanut oil Shellfish allergy One of top food allergens for adults Not usually out grown Affects ~2.7 million people (2.3% of population) Includes crustacean group: Shrimp, lobster, crabs Mollusks potentially tolerated scallops, oysters, clams, mussels Food sources: fish stock, flavorings, sushi, surimi Hidden sources: cross contamination 10

11 Soybean Allergy A legume Affects 0.4% of children (~300,000) under 18 yrs About 70% outgrow allergy Reactions are typically mild Anaphylaxis is rare Food sources: soy milk, tofu, infant formulas, soy nuts, Asian cuisine Hidden sources: processed meats and foods, canned soups, low fat and alternative peanut butters, vodka Soybean Allergy Soybean oil? Soy lecithin? Soy Allergy = Peanut Allergy? No, not related. 11

12 Tree Nut allergy Affects ~1 million people Lifelong allergy; <10% out grow it Serious and often linked to anaphylaxis Although NOT linked about 28-50% of people with peanut allergy will be allergic to at least 1 tree nut May be able to tolerate nuts other than the one(s) allergic to Sources: walnut, pecan, almond, pistachio, lichee nut, Hidden sources: baked goods, candy, garnishes, sauces, stuffed toys What is not a Tree Nut? The NOT nuts Coconut (fruit) Although FDA classifies coconut with tree nuts Reports of allergic reactions Nutmeg (spice derived from seeds) 12

13 Wheat Allergy ~75% of all grain products in the US contain wheat flour Affects 0.4% of children and 0.5% of adults ~65% of children typically outgrow Reactions span mild to severe Food sources: breads, pastas, processed foods Hidden sources: processed foods, cosmetics, bath products, play dough Wheat Allergy Generally tolerated grains: Aramanth Barley Buckwheat Corn Oats Millet Rice Rye Sorghum Quinoa Gluten Free is good for Wheat Free BUT Wheat Free is not always for Gluten Free 13

14 Gluten Intolerance Symptom of Celiac disease An example of a cell-mediated allergy Both an intolerance (hypersensitivity) and an autoimmune disorder Affects ~1% of population or 1:133 people Hereditary Lifelong disorder What is Celiac Disease? Triggered by gluten in wheat, rye, and barley in the diet Inflammation of the small intestine mucosa Causes malabsorption of nutrients Sets off intestinal symptoms &/or extra-intestinal symptoms 14

15 Clinical Presentation Younger Age Onset Abdominal pain, gas & distention Chronic diarrhea Vomiting Constipation Pale, foul-smelling or fatty stool Weight loss Failure to thrive/short stature Adult Onset Unexplained iron -deficiency anemia Bone / joint pain Arthritis Bone loss or osteoporosis Depression or anxiety Tingling numbness Infertility and recurrent miscarriages Dermatitis Herpetiformis Common Sources of Gluten Bulgur Couscous Durum Einkorn Emmer Farina Triticale Kamut Graham flour Matzo flour & meal Spelt/spelta Wheat germ Wheat starch Barley malt & extract Semolina Hydrolyzed Vegetable Protein (HVP) Bran Orzo PankoSe itan Udon Faro 15

16 Hidden Sources of Gluten Processed dairy products Processed fruits and vegetables Processed meats, fish, poultry Soups and bouillon Matzo and communion wafers Lipstick, toothpaste, chewing gum, mints Licorice and some candies Breading, coating mixes, croutons, stuffing/dressing mixes Roux, thickeners Soy sauce, marinades Modified food starch, malt and malt flavoring Supplements Medications 31 Fructose Intolerance Hereditary disorder Both parents carrying gene 25% chance child has Body missing enzyme aldolase B Body s glycogen cannot be changed into glucose Blood glucose drops Dangerous substances build up in liver Both fructose AND sucrose are problems And sorbitol Onset in infancy Irritability, jaundice, vomiting, convulsions Treatment is to remove the offending sugars from the diet and take Rx to lower uric acid & risk for gout Mild or severe Can lead to liver disease despite treatment 16

17 Allergy Prevention - POINT Evidence for prevention = weak Strategies to possibly reduce risk: Exclusive breastfeeding first 6 months OR use of hypoallergenic formula Delay introducing: solids until 6 mo. cow s milk until 1 yr. Eggs until 2 yrs. Peanuts, tree nuts, and fish until 3 yrs. Allergy Prevention-Counter POINT Full circle Introduce allergens earlier Exposure may be better than avoidance Controversial How to assess an uncommunicative infant Extenuating information Classic symptoms show (eczema) Siblings with allergies 17

18 Food Allergen Labeling Consumer Protection Act (FALCPA) of 2004 Thou Shalt Not Hide the top 8 dancecomplianceregulatoryinformation/ucm htm Labels must list ingredients using common names Sodium caseinate (milk) Every ingredient source from the top 8 allergens must be disclosed Species must be declared for nuts, fish & shellfish Gluten Free rule just came into law in 2013 NOT covered under this law Meat, poultry & eggs fall under USDA Alcohol falls under ATTB Drugs (Rx & OTC), Cosmetics, Health & Beauty items Kosher Labeling Restaurant foods 18

19 Gluten-Free Labeling Published Sept Enforced August 5 th 2014 Gluten-free ; No Gluten ; Free of Gluten ; Without Gluten Means the food does NOT contain: An ingredient that is a gluten-containing grain An ingredient derived from a gluten-containing grain Unless it has bee processed to remove the gluten <20 ppm of gluten is threshold 37 Foods Not Subject to FALCPA Raw foods Whole fruits, vegetables Foods approved as exempt Molluscan shellfish Oysters, clams, mussels, scallops 19

20 One more Caveat Any law is only as good as the ability to enforce it. Label omission vs. commission Imported goods should follow rules of destination country Ingredient U.S. Canada 1 Tree nuts almonds, beech nuts, Brazil nuts, almonds, Brazil nuts, butternuts, cashews, chestnuts, chinquapins, coconut, filberts/hazelnuts, ginko nuts, hickory nuts, lichee nuts, cashews, hazelnuts, macadamia nuts, pecans, pine nuts, pistachios or walnuts macadamia/bush nuts, pecans, pili nuts, pine/pinon nuts, pistachios, sheanuts, walnuts 2 Peanuts 3 Soybeans 4 Wheat any species in the genus Triticum, including common, durum, einkorn, emmer and club wheat, as well as spelt, semolina, kamut and triticale any species in the genus Triticum including wheat, triticale and all related hybrid varieties (e.g. kamut, spelt) 5 Eggs 6 Milk 7 Fish common name of fish common name of fish 8 Crustacean shellfish 9 Mollusk shellfish common name of crustacean (e.g. crab, lobster, shrimp) common name of crustacean (e.g. crab, lobster, shrimp) no requirement for allergen labeling common name of mollusk (e.g. clams, mussels, oysters, squid) 10 Sesame seeds no requirement for allergen labeling 11 Mustard seed no requirement for allergen labeling 12 Gluten sources other than wheat no requirement for allergen labeling barley, oats and rye, and related derivatives 20

21 Voluntary Labeling How many ways can we say maybe? May Contain: Peanuts Produced on equipment that also makes product containing peanuts. Processed in a manufacturing plant that also processes peanuts. Produced in a facility that also handles peanuts. This product is manufactured on equipment that also processes peanut containing products. 21

22 Label Sleuthing Know the source USA major manufacturer vs. Mom/Pop shop Imported vs. US based If in doubt Call the manufacturer and ask Don t serve the item Taking it into the kitchen Allergies, Intolerances and Foodservice 22

23 The allergy friendly kitchen Obligation does not end with buying the right food(s) After the menu, recipe and label sleuthing. Reduce Cross-Contamination: Storage Prep Serving Train Staff 23

24 Train Staff Vulnerable populations Don t let people with allergies trade foods Day care settings School cafeteria LTC dementia and Alzheimer residents Risk Management Know ingredients in menu items Ingredients change Have a foodservice lead (all shifts) assigned to respond to questions, special requests Identification of a food allergy should ignite a process Train staff to know what in the event of an allergic reaction 24

25 Remember It's not (necessarily) a foodservice task to distinguish between allergies, intolerances and aversions. If clients don't want a particular food item, it is the job of food service to avoid serving it. Reference & Resource American Academy of Pediatrics American College of Allergy, Asthma, & Immunology Fleischer DM et al., J Allergy Clin Immunol: In Practice. 2013;1: International Network for Diet and Nutrition in Allergy Kids with Food Allergies The Food Allergy & Anaphylaxis Network US Food and Drug Administration 25

26 Your Special Diet Partner Thank you for participating in today s session! This presentation is intended to provide general information about managing food allergies and intolerances but is not intended to provide medical advice. Presentation Author: Debra Zwiefelhofer, RD, LD 51 Post Test 1. Name the top 8 allergens that result in 90% of food allergies in the US. 2. List at least 3 things that need to be done in the kitchen to reduce risk of cross-contamination. 26