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
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).
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
Food Allergies are: An Immune reaction
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
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
Allergic Reactions Severe allergic reactions are called: Anaphylaxis
Triggers of Anaphylaxis Medications Foods Insect bites (bees, wasps, etc.) Exercise Idiopathic
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
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!
Common Allergens in the U.S. Milk, Egg Peanuts, Treenuts Fish, Shellfish Wheat, Soy These 8 Major Allergens account for 90% of reactions
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
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
Multiplier Effect Dietary restrictions affect food purchases and dining
Key Message Food Allergies are Challenging but Manageable Control the Allergens
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)
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?
If milk allergic: don t be misled... "non dairy kosher designations Product may still contain milk protein!
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
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.)
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
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!
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!
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!
Communication to Customer If employees do not communicate risks and/or precautions the establishment plans to take for the customer
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
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.
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.
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.
Avoiding Cross Contamination Be Smart: Keep Foods Apart!
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
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
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.
Cleaning Supplies Cleaner Cloth, sponges, paper towels Properly store clean items Soaps & lotions
Cleaning Practices Cleaning should include Tables including sides of table Counters Doorknobs Handles Toys etc.
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
Key Message Food Allergies are Challenging but Manageable Control the Allergens
AFAA Resources Trained Speakers & In Service Training Fliers Autoinjector Trainers & training DVDs Support Meetings, E mails, & E Magazine Restaurant Poster! (request pdf. version at info@minnesotafoodallergy.org) www.minnesotafoodallergy.org AFAA "Taking the Fear Out of Food Allergies!"
AFAA Events Camp for food allergic kids (June 11 13) Peanut free Twins Baseball Games (various dates) 4 th of July Parade Marching Minnesota State Fair Booth volunteer for free Fair admission! Conference & Expo U of M (November 6, 2010)
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 info@minnesotafoodallergy.org www.minnesotafoodallergy.org
Ingredient Substitutes For Milk: Soymilk rice milk oats milk multigrain milk potato milk water NOT goats milk!
Ingredient Substitutes For peanut butter: Sunbutter (sunflower seed) Soybutter Peabutter (yellow lentils) Almond butter Cashew butter
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
How? Why? Exposure (sensitization) is necessary to develop allergy eating food babies mouthing toys or objects exposure through breastmilk pregnant mom s diet?
How? Why? Exposure (sensitization) is necessary to develop allergy eating food babies mouthing toys or objects exposure through breastmilk pregnant mom s diet? NO!