What the Food Service Worker needs to know By Rachel Mathisen Food Allergies What the Food Service Worker needs to know By Rachel Mathisen

What is a food allergy? It is an immune response usually to one or more proteins in a food. In a food allergy the child’s body identifies the protein in a food as foreign or invader and mounts a defense against that protein. The body declares war on the invader by releasing chemicals like histamine and all sorts of symptoms can appear. Unfortunately, it is the child who suffers

Food Allergy vs. Food Intolerance They are not the same! An immune response The reaction occurs each time the child is exposed to the food Only a small dose is required May cause life-threatening symptoms Usually the symptoms appear quickly Not an immune response Symptoms may not occur every time the food is eaten Usually takes a larger dose Uncomfortable, but symptoms are usually not serious Symptoms may take several hours to appear * This slide was adapted from “Guide to Food Allergy Management” by Chartwells School Dining Services

Food Intolerance Lactose intolerance is a prime example. People with lactose intolerance can have some milk products with no side effects But people with a true milk allergy must avoid all dairy products and all forms of cow’s milk or risk having an allergic response.

Food Allergy Symptoms Redness Rashes, hives Itchy eyes Swelling Asthma Difficulty Breathing Vomiting, diarrhea, stomach cramps Anaphylaxis Death Photo: http://www.enyfoodcoop.com/healthy-tips/food-allergies/

Eight Most Common Food Allergies 90% of food-related allergic reactions are caused by these 8 foods: Peanuts Tree Nuts Milk Egg Fish Shellfish Soy Wheat Adapted from: Food Allergy Foundation (2011): Food Allergies in America. http://foodallergyfoundation.org/food_allergies “Scientists estimate that as many as 15 million Americans suffer from food allergies, including approximately 6 million children. Food allergies affect an estimated 6 to 8 percent of children under age 5, and about 3 to 4 percent of adults. 90% of all food allergy reactions are cause by 8 foods: milk, soy, eggs, wheat, peanuts, tree nuts, fish and shellfish. Food allergies account for 30,000 visits to the emergency room each year. More than 200 deaths occur each year due to food allergies.” 90% figure also comes from http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Allergens/ucm106187.htm

How much of a food does a child have to eat to cause an allergic reaction?

It Varies From Person to Person! Some people have only mild symptoms when they eat small amounts of the food – itchy eyes, reddening of skin Some people have a severe reaction if even smallest amount of the food touches their lips! Some people cannot be in the same room with the food Most commonly seen with peanut and tree nut allergies! Photo: /url?sa=i&source=images&cd=&cad=rja&docid=Xm0C_UW_8n_qUM&tbnid=KplHporKMezXGM:&ved=0CAgQjRwwAA&url=http%3A%2F%2Fwww.migration24x7.org%2Fasthma%2Ffirst-aid-treatment-for-asthma-attack%2F&ei=nHi-UbnZHYeK9QSylYHgDQ&psig=AFQjCNGOMjEiNFzm8y7UzyjanEDkyPag8A&ust=1371523612529228

The scary thing about food allergies is that symptoms can become worse with every exposure to that food.

SYMPTOMS CAN BECOME WORSE! A child may usually just get swollen lips, but may suddenly have his throat swell shut after an accidental exposure to the food! Photos: http://www.clinicaladvisor.com/food-allergies/slideshow/226/ ; http://blog.centralrestaurant.com/index.php/2012/06/the-new-bully-in-our-schools-food-allergies/

Prevention and Treatment of Allergies Preventing Allergic Reactions: The only way to prevent allergic reactions to a food is to avoid contact with that food. Treatment: Epinephrine Benadryl Photo: http://judgeallergyasthmasinus.com/services_allergic_reaction.html

Special Allergy Menus For each child with a food allergy who eats school meals, the dietitian writes a special menu which lists the foods the child can safely eat on that day! Picture: http://bryanking.net/beware-of-allergies-and-reactions/

Special Allergy Menus If a child in your school has a food allergy you will receive a weekly allergy menu for that child Each allergy menu is written for a specific child Do not make any substitutions – even if the foods seem similar! Only give the condiments listed as okay on the menu—there is a reason if we say “no Ranch dressing or mayonnaise”

How could an accidental exposure occur? Hidden or unexpected ingredients The dietitians read every product label before giving the okay Cross contamination Product substitution

Avoiding Cross-Contamination Clean and sanitize all work surfaces and tools before beginning each task If possible, designate a special area for preparing food for students with food allergies Prepare foods containing offending ingredients last Use a clean knife or spoon for each task Do not use the same utensil to serve two different foods Don’t remove the food the child is allergic to from a mixed product and call it allergen-free

What should you do if the supplier makes a substitution? You notice that it is a different brand for the breaded chicken patties? Or you’ve got nuggets not patties? Call one of the dietitians BEFORE you give a child with a food allergy the new chicken patty!!!

Can you substitute the spicy breaded chicken patty for the If the child’s allergy menu specifies a breaded chicken patty as an entrée, but you’ve run out of them. Can you substitute the spicy breaded chicken patty for the breaded chicken patty?

NO! Not without checking with a dietitian!

Reading Labels Reading Allergy Labels Can Be Tricky! You can check the label and see that the allergen is present in the new food, but you shouldn’t decide that the food does not contain the allergen! Reading Allergy Labels Can Be Tricky!

Allergy Labeling By Law food manufacturers must label all foods that contain any of the 8 most common allergens: Egg, Wheat, Milk, Soy, Peanuts, Tree nuts, Fish, Shellfish This sign is usually in bold letters at the bottom of the label—But Not Always. Food Allergen Labeling and Consumer Protection Act of 2004 (Public Law 108-282, Title II)

Allergy Labeling Or it may say: processed on equipment that also processes peanuts. If a child has a peanut allergy he can’t have this food.

Allergy Labeling The label may have a long list of ingredients and somewhere towards the end have the term casein (milk) and you may not easily see it. /url?sa=i&source=images&cd=&cad=rja&docid=BzFqCtO5IhCdkM&tbnid=ZdCBIgvrIKDOuM:&ved=0CAgQjRwwAA&url=http%3A%2F%2Fwww.healthcentral.com%2Fallergy%2Fh%2Fallergy-label-clip-art.html&ei=PIe-UaaPBoWc8wS51IDgBg&psig=AFQjCNGmBEJ2aBqpBxvjq_bWYiAX-0t3Bg&ust=1371527356150988

Allergy Labeling http://www.tpgtex.com/allergen_warnings.html FALCPA - Is the Food Allergen Labeling and Consumer Protection Act of 2004. FALCPA addresses the labeling of all packaged foods regulated by the FDA. In Addition labeling having to do with meat products, poultry products, and egg products are regulated by the U.S. Department of Agriculture (USDA.) Major food allergen is an ingredient that is one of the following eight foods or food groups or an ingredient that contains protein derived from one of them: milk crustacean shellfish fish egg tree nuts wheat peanuts soybeans Although more than 160 foods have been identified to cause food allergies in sensitive individuals, the "major food allergens" account for 90 percent of all food allergies. Allergens other than the major food allergens are not subject to FALCPA labeling requirements. Tree nuts, Crustacean shellfish and fish must be declared specifically. For Tree Nuts: almonds, pecans, walnuts, etc. For fish: bass, flounder, cod, etc. For Crustacean shellfish: crab, lobster, shrimp, etc. Wheat refers to any species in the genus Triticum: wheat, durum wheat, club wheat, spelt, semolina, Einkorn , emmer, kamut and triticale. FALCPA requires food manufacturers to label food products that are made with an ingredient that is a major food allergen in one of the following two ways: http://www.tpgtex.com/allergen_warnings.html

Allergy Labeling But sometimes they are NOT listed at the bottom, but are found within a long list of ingredients on the label – they may be hard to see! And what if the child is allergic to corn? Could you recognize all the names used for corn? Dextrose Maltodextrose Hominy And many more

Allergy Labeling You are not expected to read the product labels When a new product comes in, alert the dietitians to make sure they are aware of the product change. Save a label of the new product for the dietitian to view. Remember – Don’t make any substitutions without checking with the dietitian!!!

Prevention Follow recipes and menus exactly Do not make any substitutions without checking with a dietitian Properly identify students – make sure you are giving the right diet to the right student!

What if a child has a severe allergic reaction? Get the teacher or principal or another person in charge. Or if you really think it is an emergency and can’t wait (the child has stopped breathing) Call 911!

The End Any Questions?