Transcript Controlling Allergens: Preparing and Serving Food Safety in School

Controlling Allergens:
Preparing and Serving Food
Safety in School Kitchens
Ben Chapman, PhD
Katrina Levine, MPH, RD, LDN
May 28, 2015
What is a Food Allergy?
• Immune system has a negative reaction to
something in a food
• Something in the food causes the immune
system to produce antibodies (IgE). When the
person has that food component, it triggers
the antibodies, which alert the immune
system to react, causing an allergic reaction
• NOT a food sensitivity or intolerance
Why are they important?
• Affects 4-8% of children and 2% of adults
in the U.S.
• Leading cause of anaphylaxis
• Each year, anaphylaxis due to food
causes
– 30,000 emergency room visits
– 2,000 hospitalizations
– 150 deaths
Building Blocks of Food
• All foods are built of macro- and
micromolecules
• Macromolecules:
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–
–
Proteins
Nucleic acids
Carbohydrates
Lipids (fats)
• Micromolecules include:
– Vitamins
– Minerals
What is an Allergen?
• Allergens are always proteins
• Proteins are macromolecules composed of one or
more chains of amino acids
• Proteins are found in all living organisms, so in
most food products
• Proteins should not be confused with oils and
sugars
– Refined/filtered oils only contain lipids and won’t
cause allergic reactions
– Lactose is a sugar, so lactose intolerance is not an
allergy
What Causes
an Allergy?
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•
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An allergy is a immune
response to a protein
(allergen)
The body is exposed to a
protein and mistakes it for a
harmful substance
The immune system
produces antibodies to
protect against the allergen
When the body detects the
protein again it reacts as if
the substance is harmful,
releasing a storm of immune
substances, stimulating a
reaction
In some cases, only a trace
amount of the protein is
required to produce an
immune reaction
What does an allergic reaction look like?
• Hives
• Flushed skin or rash
• Tingling or itchy sensation in the mouth
• Face, tongue, or lip swelling
• Vomiting and/or diarrhea
• Abdominal cramps
• Coughing or wheezing
• Dizziness and/or
lightheadedness
• Swelling of the throat and
vocal cords
• Difficulty breathing
• Drop in blood pressure
• Loss of consciousness
How child describes reaction
• Put hands to mouth, pull or scratch tongues,
voices may change
• “Food is too spicy”
• “My tongue is hot, something is poking it”
• “My mouth is tingly, itches, or feels funny”
• “My tongue feels full, my throat feels thick”
Top 8 Allergens (90%)
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Eggs
Milk
Soy
Wheat
Peanuts
Tree nuts (almonds, walnuts, pecans,
etc.)
• Fin fish
• Shellfish (crab, shrimp, lobster, etc.)
Food Intolerance
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More common than allergies
Histamine toxicity (cheese, wine, fish)
Lactose intolerance
Food additives (MSG)
Gluten intolerance (small intestine)
Corn products
True allergy – avoid food (immune system)
Intolerance – small amount is ok (digestive system)
What about gluten?
• Damages the intestines in people
with Celiac Disease
• Immune system responds
differently in people with Celiac vs.
sensitivity or intolerance
• FDA Final Rule in 2014 on
definition of “gluten-free” for
packaged products
• FDA does not regulate labeling of
“gluten-free” in schools
Allergens in the kitchen
• Hidden sources of allergens
– Soups, sauces, dressings, mixes, cookies, crackers,
baked goods, etc.
• Cross-contamination
– Direct contamination of equipment and surfaces
– Indirect contamination through particles in air
• What to look for:
By law, labels must alert
to all potential allergens
in the product
• Dairy: whey, casein, milk/cheese (any
form)
• Egg: albumin, globulin, egg (any
form)
• Wheat: bran, flour (any form),
durum, gluten
• Soy: lecithin, edamame, soy protein
• Peanuts & Tree nuts: nuts (any
form), marzipan, artificial nuts
• Fish & Shellfish: surimi, seafood
flavoring, fish/shellfish (any form)
• There are many more aliases as well
http://www.corbisimages.com/stock-photo/rights-managed/42-16456772/food-allergy-warning-label-on-package-of
Equipment and
surfaces
• Everything from mixers and
pans to utensils to tabletops
• Cleaning and sanitizing
critical between uses
– Dishwashing method
• Storing equipment
– Covered
– Upside down
Particles in the air
• Dust from things like
flour or meal
– Making pizza and bread
– Coating pans to prevent
sticking
• Can settle on
equipment, surfaces,
utensils, food or
ingredients
Other ways to
cross-contact
• Cooking oil used in
frying
• Garnishes and toppings
• Hands and gloves
In the cafeteria
and on the line
• Labeling
• Separating
• Communicating
Know your school’s
protocol
• Your school should have
a plan for how to handle
food allergies
• Know the protocol and
how you fit into it
• Talk to your school nurse
or CND
Labeling is important
• 13-year-old Natalie Giorgi
died at a family camp
after eating a Rice Krispie
treat with traces of
peanut butter in the
marshmallow
• Camp had failed to
properly label foods, as
they had in the past
• EpiPen was not effective
and she died of
anaphylactic shock
http://www.sacbee.com/news/local/health-and-medicine/article2596198.html
Cross contact
• Sabrina Shannon, 13,
died of cardiac arrest
due to anaphylactic
shock
• Sabrina ate plain french
fries that had been
served with tongs used
for cheese fries
• Cross contact of dairy
protein caused the
reaction
Establish a Food Allergy Expert
• A food allergy expert:
– Knows the recipes, ingredients, and potential
allergens
– Knows the students with food allergies
– Knows how to respond in a food allergy
emergency
http://3.bp.blogspot.com/-O4NR28njoXU/UnDHqvETv0I/AAAAAAAAY7M/ehE4Nsf62Is/s1600/Fotolia_35754864_M_Expert.jpg
Resources
• “Food Allergy Training Guide for Hospital and
Food Service Staff,” American College of
Allergy, Asthma & Immunology
(http://www.foodallergy.org/document.doc?i
d=149)