MANAGING FOOD ALLERGIES IN LONG TERM CARE. Anna de Jesus, MBA, RDN President, Nutrition Alliance, LLC

Transcription

1 MANAGING FOOD ALLERGIES IN LONG TERM CARE Anna de Jesus, MBA, RDN President, Nutrition Alliance, LLC

2 Objectives The increased proliferation of food allergies has created a more complex dining culture for resident in long term care. This session will help you gain helpful insights into understanding, managing, and accommodating dietary restrictions.

3 Overview Background information Symptoms of food allergies Preventing food allergies in the kitchen and providing alternatives Food allergies vs. food intolerances Symptoms of intolerances Documenting allergies and intolerances Gluten free kitchen

4 What are food allergies? Food allergies are when your body s immune system reacts to a substance in a food and usually sets off a chain reaction leading to symptoms.

5 Food Allergy Facts About 15 million Americans have food allergies. The number of people being diagnosed with food allergies is growing. Food allergies can begin at any age. Anti-histamine may help alleviate symptoms, however, if symptoms begin to pose a life-threating reaction is a medication called epinephrine (commonly called epi-pen) should be administered AVOIDNG THE FOOD IS THE BEST LINE OF DEFENSE

6 Symptoms Symptoms can occur within minutes and can range from a simple runny nose to a life threatening event. Symptoms can include: Fever Hives/eczema Swelling of any parts of body Nausea Vomiting Diarrhea Difficulty breathing, coughing, wheezing

7 Food Allergy Symptoms

8 Common Allergies More than 170 foods are known to cause allergies 8 common foods account for 90% of all food-allergic reactions: Eggs Fish Shellfish Soy Milk Peanuts Tree nuts Wheat

9 Common Allergies in LTC In adults, peanuts, tree nuts, finned fish, shellfish, fruit, and vegetables account for 85% of the food-allergic reactions American Journal of Lifestyle Medicine

10 Oral Allergy Syndrome Allergic reaction to certain foods (usually fresh) that develop in hay fever sufferers Immune systems mistakes the food protein for pollen protein May not react until the 5 th strawberry is eaten during peak pollen season but no effect during low pollen season just like an intolerance

11 Pollen and fruit/vegetable cross connectivity If you are allergic to: Birch pollen Ragweed pollen Grasses Mugwort pollen You may have a reaction to: Apples Peaches Plums Nectarines Cherries Carrots Celery Hazelnuts Almonds Raw potatoes Melons (watermelon, cantaloupe and honeydew) Bananas Tomatoes Melons Kiwis Tomatoes Carrots Celery Spices

12 Food Allergy or Intolerance? Food intolerance occurs when your body can not process or absorb certain components of food. The difference: symptoms of intolerance is unpleasant however not life threatening. Intolerances become more well known with the elderly population where GI functions that were once efficient become impaired with age and disease.

13 Common Food Intolerances Lactose (mainly milk and other dairy products) Gluten (wheat, bran, rye, oats) Sucrose intolerance (sugar, sugar cane, beets) Sobital malabsorption (sweeteners, some cough syrups and mouth washes) Fructose malabsorption (most fruits and some sweet vegetables) Fat intolerance (oil, lard, fatty meats)

14 Symptoms of Food Intolerances Diarrhea and/or constipation Abdominal pain and sometimes cramping Nausea Excessive belching Abdominal bloating

15 The Big Eight Eggs Fish Shellfish Soy Milk Peanuts Tree nuts Wheat

16 Lactose Free Great form to have available to staff: odallergy.org /document.do c?id=133

17 Egg Free Great form to have available to staff: odallergy.org /document.do c?id=133

18 Wheat Free Great form to have available to staff: odallergy.org /document.do c?id=133

19 Soy Free Great form to have available to staff: odallergy.org /document.do c?id=133

20 Shellfish Free Great form to have available to staff: odallergy.org /document.do c?id=133

21 Tree Nut Free Great form to have available to staff: odallergy.org /document.do c?id=133

22 Peanut Free Great form to have available to staff: odallergy.org /document.do c?id=133

23 Fish Free Great form to have available to staff: odallergy.org /document.do c?id=133

24 Common hidden food allergens Worcestershire sauce. This sauce contains anchovies and/or sardines; both are fish. Barbecue sauce. At least one brand of barbecue sauce contains pecans, which are listed on the label. Imitation butter flavor. This ingredient often contains milk protein. It could be listed on the ingredient statement as either artificial or natural butter flavor. Sweet and sour sauce. Some brands of sweet and sour sauce contain wheat and soy. Egg substitutes. Most brands of commercial egg substitutes contain egg white. Tuna. Some brands contain casein (a milk protein) or soy protein as a natural flavoring. Eggs. Eggs may be used on frozen soft pretzels as an eggwash. Peanut butter. Peanut butter has been used to thicken chili, salsa, spaghetti sauce, and brown gravy. It has been used as the glue to hold egg rolls together. It has also been used to add crunch and texture to piecrusts and cheesecakes and has even been used in brownies and hot chocolate. If your hospital purchases any of these items and does not prepare them in-house, it is wise to avoid them for patients with peanut or tree-nut allergies..

25 How to avoid food allergies? FDA Food Code requires that the Person In Charge (PIC) is able to describe food identified as major allergens and symptoms that a major food allergy can cause in an individual who has an allergic reaction. Who is your PIC?

26 How to avoid food allergies? Food allergies must be avoided at all cost and therefore should be left out of the resident s diet. Read labels to ensure the food being prepared does not contain or may contain the allergen

27 Reading Labels

28 Avoiding cross contamination Unclean hands or gloves. Wash hands thoroughly and put on a fresh pair of gloves before preparing an allergy-free meal. Cross-contamination. Using cooking utensils, such as spatulas, cookie sheets, or prep stations, for both allergen-containing and nonallergen-containing products. Wash them in between uses. Splashed or spilled food. It is very easy to accidentally contaminate a patient s food, drinks, or utensils when carrying them on a tray with other items. Ingredients from other foods can splash or spill onto something that is otherwise allergy-free. Trays. As an extra precaution, trays used to carry allergy free meals should first be cleaned thoroughly with hot, soapy water, not just wiped down. Garnishes. In order to minimize the chance for mistakes, only the Food Service Department supervisor, manager, or other designated staff member should decide how to garnish the plate.

29 Making up for nutrients in diet Provide alternatives to make up for lack of protein/nutrients. Consider multivitamin with minerals or Fish oils to help with lack nutrients.

30 Alternatives: Milk: Substitute an equal amount of rice milk, soymilk or almond milk in recipes Soy: look for soy free products

31 Alternatives: Eggs: egg alternatives Fish/shellfish: use poultry, beef, pork, milk/soy products

32 Alternatives: Tree nuts/peanuts: Dry fruit Wheat (gluten): rice or potato based products

33 Avoiding allergies and intolerances in LTC? Food preference sheets Interview the patient upon admission to find out they have a food allergy or an intolerance. If patient reports an allergy, find out the degree of reaction by asking what their symptoms are. Update tray card and/or allergy spreadsheet for the whole house to make kitchen staff aware. Educate staff on food allergies and crosscontamination.

34 Documenting Always document the interview and findings in progress notes Create care plan Problem: therapeutic diet r/t food allergy Goal: Resident will not experience any s/s of allergic reaction through next review Interventions: avoid food allergy-shellfish Note: if resident requests for foods causing intolerance or allergy DOCUMENT AND CARE PLAN (i.e. claims to have a lactose intolerance but request for a small amount of milk in am) directs own plan of care r/t food choices with noted intolerance to milk aeb request for 4oz milk on breakfast tray

35 Providing Allergy Friendly Menus Instead of Carrot Cake Oatmeal Cookie Meat Lasagna Raspberry Vinaigrette Chicken Stir Fry Describe as Carrot Walnut Cake Oatmeal Walnut and Raisin Cookie Meat Three Cheese Lasagna Raspberry and Walnut Vinaigrette Cashew and Chicken Stir Fry

36 Case Study

37 Work Cited: /2008_spring.shtml Food Allergy Training Guide for Hospital and Food Service Staff.The Food Allergy & Anaphylaxis Network11781 Lee Jackson Highway, Suite 160 Fairfax, VA 22033

38 QUESTIONS? Anna de Jesus, MBA, RDN