Transcript Food allergies and intolerances

Food allergies and
intolerances - Module 2
Identifying / locating
allergens
Module 2 - Learning Outcomes
This section will look at the common 14 plus allergens by
identifying each, where they are found, and with examples
of prepared foods hiding the allergens.
1. You will learn the source of each allergen, where it may
be hidden in processed foods and the likely symptoms.
2. You will have an understanding of allergens and where
they are to be found so that you can maintain effective
communication with your customer.
3. You will have the underpinning knowledge to prepare a
hazard analysis. Hazard analysis and HACCP we will meet
in the next and final section
Module 2. Identifying Allergens Where are
allergens commonly found?
• In this section you will learn about each of the common
allergens, and where they are found. It is important that
you are aware which foods contain allergens so that you
are able to prepare all dishes with a full knowledge of their
allergen content.
• (In Section 3 we will focus on the practical measures that
you can apply during your daily working routine to ensure
that the risk of allergen contamination is eliminated.)
Keeping Records
• This will form part of your HACCP system as all allergens
and intolerances must be considered as a hazard.
• New legislation from December 2014 requires every food
outlet to be able to inform their customers which dishes
contain which allergens.
• To be able to do this you need to know where allergens
are to be found, in which products allergens are used as
ingredients, these we call hidden allergens.
• Knowing where the allergens are in your kitchen is an
important part of your HACCP system.
14 Allergens
• European Legislation has identified the 14 common
allergens – But, there are more than 200 foods that are
known to have caused an allergic reaction.
• It is impossible to predict exactly which foods a customer
may react to, showing just how important it is to listen to
your customer.
• The list of 14 does not give a complete picture so be
aware that other foods can cause reactions too.
• A few more than the 14 items have been included in this
course
Peanuts
Probably the fastest growing
allergy that often affects
children from infancy.
Most people with a peanut
allergy will also be allergic to
other nuts, so all must be
eliminated from the customer's
meal.
Peanuts are a common snack
and the crumbs are very easily
found at home in clothes and
furniture.
These small amounts can
cause a reaction.
Peanuts cont.
• Peanuts are one of the most dangerous allergens
because only a tiny amount is required to cause an
anaphylactic reaction, which can be fatal.
• Food handlers should not eat peanuts at work.
More about peanuts
• Heating does not make not an allergen safe but in Europe peanut oil is
safe because during the refining process the allergen has been removed.
Walnut oil must be avoided as this contain a lot of nut allergy proteins
which can cause a reaction to a person suffering from a peanut allergy.
• Peanuts are not actually nuts but are a vegetable, a legume the same
group as peas and beans. However, most people who have a peanut
allergy are also allergic to nuts. So when a person tells you that they are
allergic to peanuts you need to ensure that no nuts are in their food.
Anyone with either a nut or peanut allergy need to have both eliminated
from their food.
• It it is common to find that when a person has an allergy to one allergen,
they will have an allergy to similar products such as peanuts and nuts.
This reactivity to more than one allergen is called cross-reactivity.
• If you work in a restaurant, using peanuts in many dishes such as a Thai
restaurant, it will be impossible to ensure safety for a person suffering
from a peanut allergy. Therefore there should be a clear warning on the
menu such as:
We use peanuts in many of our dishes and if you are allergic to
peanuts we kindly advise you to choose another restaurant as we
cannot promise that any of dishes are peanut free.
Only tiny amounts can cause reaction
• The smallest amount of a peanut can cause a dangerous
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reaction.
It is so tiny that it is airborne - that means that any allergy
sufferer being near peanuts is at risk.
It can be very dangerous to have open peanut displays or
to place peanuts on the table or bar.
Contamination from food or drinks staff serving an
allergic customer.
Peanuts are one of the most dangerous allergens not only
because only the smallest amount is required but also
that it can cause an anaphylactic reaction.
Where may peanuts be found?
As even the smallest amount of peanut is dangerous which foods contain peanuts?
• Peanuts are found in a wide range of snacks and
confectionary
• Marzipan is made from almonds yet the almond paste
may contain peanuts. This is because peanuts are less
expensive than almonds
• Peanuts are found in nougat
• Peanuts are found in flour as used in Indian dishes
• Peanuts are in a number of sauces
• Satay and pesto use peanuts
Nuts - Tree Nuts
Nuts allergies are closely related to
peanut allergies and also sesame
seeds. All 3 can cause anaphylactic
shocks. This reactivity to more than
one allergen is an example of
cross-reactivity. Nut allergies are
also increasing.
It is wise to treat anyone with a nut
allergy, a peanut allergy and a
sesame seed allergy as one and the
same so eliminate all of them
entirely from their meals.
This may sound complicated, yet
understanding cross-reactivity
combines several allergens into a
single group, which can be easier to
manage. (More detail in Section 3)
This group includes all nuts:
• Walnuts
• Brazil nuts
• Macadamia
• Cashew
• Chestnuts
• Hazel nuts
• Pecan
• Pine nuts, also known as pignolia
• Pistachios
Foods commonly containing nuts
• Pesto - Italian paste made with pine nuts
• Marzipan - almond paste, which sometimes may contain
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peanuts
Nutella - a chocolate and nut spread
Baklava - a well know Greek/Turkish dessert made with a
variety of chopped nuts
Nougat - a range of nuts including almonds, hazelnuts,
pistachios and walnuts
Turron - a Spanish version of nougat with many different nuts
Gianduja - chocolate paste with hazel nuts
Biscuits /cookies
Fruit cakes
A wide selection of confectionary and ice creams
Chocolates
Care with nuts
• Nuts are commonly added to many dishes, especially
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confectionary and desserts. All processed foods such as
biscuits must be carefully checked and recorded.
As part of hazard analysis you will need to check every
item to build a list of all products containing allergens to
allow you up to date information for your customer.
Recipe development and planning will be discussed later,
but it is important to consider garnishes.
It is best to avoid garnishing with any allergen item. If an
allergen is used, the dish must be clearly labelled so that
all of your colleagues know that the dish contains
allergens
Careless garnishing has killed!
Sesame seeds
• Sesame seeds allergy is similar to that
of peanuts and tree nuts, so the
customer needs to have all 3
eliminated from their food.
• Sesame seeds can produce an
anaphylactic reaction. They are used
extensively in Middle Eastern cuisine
and therefore unsurprisingly the
greatest increase in sesame seed
allergies is in people from this region.
• Sesame has long been a staple part of
the cuisine for more than 3,500 years
as recalled by historian, Herodotus.
• Sesame seeds as used for oil needs to
be avoided as not all refining
processes remove the allergen.so
must be eliminated from the
customer's meal.
Foods containing sesame seeds:
• Tahini - a paste made from ground sesame seed
• Hummus - a blend of olive and tahini, sesame seed paste
• Baba Ghanoush - frequently seasoned with sesame seed
oil or its paste, tahini.
• Bread and Buns - sesame seeds added for flavour and
texture fast food chains use sesame seeds on their
hamburger buns.
• Crackers Japanese salads and many Japanese prepared
dishes including gomashio made from roasted sesame
seeds.
• Indian cuisine uses sesame seeds including black seeds
for sesame seed balls
Use of sesame seeds
• Biscuits and cookies
• Sesame bars
• Bread sticks
• widely used in a variety of cuisines ranging through the
Middle East, the Maghreb, North Africa, Greece, Turkey,
Pakistan, and India and in oriental cuisine both Japanese
and Chinese.
• It can be found in salad dressing and Japanese dips for
sushi and sashimi.
Mustard and Mustard seeds
• Mustard - a well known
condiment but it also finds its
way many recipes such as
mayonnaise and sauces, both
purchased ready made and
prepared on the premises. This
emphasises the importance of
record keeping and label
checking.
• In the most severe reaction an
anaphylactic shock can occur,
though fortunately mustard
allergies are fairly rare.
Foods that may include mustard:
• Barbecue sauces
• Tomato ketchup
• Marinades
• Mayonnaise
• Meat that has been processed such sausages
• Seasoned flour used for batter such as for frying fish
• Pickles - piccalilli
• Salad dressings - vinaigrette
• Many spices and seasoning mixes
• Gravy mixes
• Curry sauces
• All pre-prepared dishes and ready meals
More uses for mustard
This allergen though less common as an allergy is found is many
foods both purchased and prepared.
• Mustard is used for many seasoning applications and is
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required to be on all labelled food. For your recipes always
keep a record of all the ingredients.
Mustard oil - this is used for frying especially in North Indian
curries so it is not only the seeds that are used for food
Mustard leaves are used in salads. Mustard sprouts are used
again in salads. You need to check the mixture of leaves in
your pre-packaged salads.
Cross reactivity there are growing signs that those with a
mustard allergy will also react to colza oil, also known as rape
seed oil.
Mustard oil is widely used in many processed foods.
Lupin seeds from the lupin plant
• Lupin seeds are ground into
flour for pastries.
• It is not commonly used in UK
but it is fairly common in
France. This makes checking
all prepared foods especially
pastries from France essential
and also adjusting your supplier
specifications.
• Fortunately, for this type of flour
there are common substitutes
and therefore it is fairly easy
not to purchase any productcontaining lupin.
Typical products that may contain lupin
include:
• Pastries especially pastry cases and shells
• Waffles
• Pies
• Pancakes
• Pizza
• Batter and flour mixes used for deep-frying
Cross reactivity all those with peanut allergies have been
advised to eliminate lupin from their diet
Soya
• Soya belongs to the vegetable family
legumes, which include peanuts and
lupin. However, it is less cross
reactive with peanuts than other
allergens.
• Soya is very common in all diets and
is found in many processed foods.
• It is used as flour as well as an oil,
and as a direct ingredient such as soy
sauce; therefore there are many
products in which it can be found.
• As with all these allergens the
importance of thoroughly reading and
keeping labels of all processed foods
cannot be underestimated.
Typical soya products include:
• All baked products including bread:
• Vegetable protein - often called either hydrolysed vegetable
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protein HVP or textured vegetable protein TVP.
Lecithin E322 - this is an emulsifier, an emulsifier makes the
combination of liquids smooth and consistent such as
mayonnaise, therefore you will find emulsifiers in many sauces
and salad dressings, spreads and margarines. Lecithin is
normally made from unrefined soya oil.
Soya oil, refined soya is considered to be safe as the allergen
has been removed during refining, however unrefined soya oil
should be avoided in all circumstances.
Soy sauce - a common condiment found in Japanese and Far
Eastern cuisine.
Tofu - also known as soya bean curd and frequently used as a
meat substitute and in vegetarian dishes.
Gluten - the protein in flour
• Gluten made of 2 proteins is in
many flours giving bread dough
its elasticity; so is an important
part of baking and is found in
pasta as it is also made from
wheat flour, durum wheat.
• Allergies affect different people
in different ways, ranging from
the less severe gluten
sensitivity to more serious
coeliac disease.
Gluten can be found in the following foods:
• All bread and baked products
• Cereals
• Pasta
• Pastries
• Biscuits
• Desserts
• Couscous
• Semolina
• Tabouleh
It may be more difficult to identify when
flour is used in sauces and mixtures:
• Gravies
• Many sauces
• Soups
• Processed vegetable dishes
• All battered items such as fish for frying
• Condiments
• Beer
• Vegetable starch
The list is very long, but fortunately there are substitutes
that can provide a gluten free alternative.
Gluten free substitutes
There are a variety of alternative flours that can be safely
used these include:
• Potato flour
• Rice flour
• Maize or corn (cornflour)
• Soya flour
• Buckwheat
• Chickpeas beans and lentils
• Arrowroot
It is reasonably simple to change your recipe for a sauce by
using arrowroot or corn flour as alternative thickening
agents.
Celery and Celeriac
• This allergy is more
commonly found in central
Europe and Switzerland
and shows a cross
reactivity with a number of
pollens.
• Generally it is the celeriac
root, which causes the
most severe reactions, and
cooking will not reduce its
effect.
Celery can be found in:
• Celery sticks and mixed salads
• Celeriac root
• Stocks, stews and soups
• Celery as a seasoning - all products containing celery will
be labelled, and must be eliminated from the customer's
meal.
• Once again the importance of accurate and complete
record keeping is paramount.
Fish, Molluscs and Crustaceans
• This group of 3 can be seen
together but also separately.
• Some people are perfectly
able to eat fish such as cod
but not shrimp, so there is a
difference between fish,
shellfish called crustaceans
and molluscs, bi- vales
oyster and mussels.
• Generally, people who have
a reaction to one type of fish,
mollusc or crustacean can
react to the others.
Fish molluscs and crustacean can be
found in:
• Processed fish products
• Worcestershire sauce & Gentleman's Relish contain anchovies
• Oyster sauce - used in Chinese and oriental dishes such as
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stir-fry
Shrimp sauce - frequently used in Japanese and Chinese
cooking
Anchovy sauce - this may be used in gravies and sauces
Taramasalata
Remoulade sauce - again some recipes include anchovies
Compound butters - shrimp butter and cafe de Paris butter
again containing anchovies and Worcestershire sauce
Molluscs
This group of shellfish includes 3 sub
groups:
• Bivalves - mussels, oysters,
abalone, scallops and clams
• Cephalopods - octopus, squid (also
know as calamari) cuttlefish
• Gastropods - snails (escargot)
limpets, winkles
• In most cases it is clear that these
foods are easy to identify and to
keep separate, but some are used
as interesting ingredients.
• Oyster sauce as mentioned before,
is very common in Chinese cooking
and can be found in many sauces
especially those used in wok style
preparation.
Crustaceans
• This group includes shrimps, prawns,
crab, crayfish and lobster. All very
popular foods and easy to identify but
are hidden ingredients in many
processed foods and sauces, such as
shrimp sauce used in oriental cooking.
• Fish and shellfish make up a large
group of allergens and find their way
into many sauces and other complex or
processed foods.
• Shrimps, prawns and other shellfish are
often used as garnishes so the fact that
they are allergens must be considered.
• Carefully, read the labels of all
purchased sauces so that you know
exactly what is contained in each. This
is an essential part of your record
keeping system.
Eggs
• Even the widely used egg can cause
an allergic reaction. It is impossible
to list all the foods that can contain
eggs. This is the second most
common allergy amongst children,
the first being milk.
• As with many other allergens egg
content is required to be listed on all
products by European legislation.
• Eggs have two parts, the yolk and
the white, some people may be
allergic to one and not the other, or
both; there is nothing simple about
allergies. As always, ‘fail safe’, the
recommendation is to eliminate all
parts of the egg both white and yolk
from the customer's meal.
Eggs as ingredients
It is difficult to write a full list of all foods containing eggs but
examples are:
• A wide variety of egg dishes or where eggs are the main
ingredient
• Cakes
• Pastries
• Choux paste
• Sauces - hollandaise, mayonnaise plus many more
• Ice cream
• Sorbet - as a stabiliser
• Preservatives - even processed ham.
More about eggs
• Eggs are commonly used in the kitchen and sometimes
there will be breaks and spills on work surfaces, which
should always be immediately cleaned, (Food Safety and
chance of an allergen contamination).
• The list of products containing eggs is long therefore you
will need to identify all the products served in your kitchen
containing eggs either the white or the yolks so all
employees are aware which products eggs or egg
derivatives such as powdered egg can be found.
• Powdered and dried eggs are added to many products,
again it is essential to make a record of all the products
and their ingredients.
Milk
• Milk is a food that causes
intolerance, lactose
intolerance and an allergy;
milk allergy is the most
common of all allergies
amongst babies and
children.
• (Already discussed in Unit
I.)
Milk products include:
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Milk as a drink or drink base (hot chocolate and milkshakes)
Cheese
Yoghurt
Cream
Ice cream
Butter
Fromage frais
Creme fraiche
Pastry creams and custards
The hidden allergens may be found in a wide range of products including:
• Pastries
• Bread
• Biscuits and cookies
• Many sauces such as bechamel and its many derivatives such as mornay sauce
• Desserts
• Dry drinks mixes such as hot chocolate and Ovaltine
Remember label reading and recording all ingredients in your house recipes, you will then have
a complete list of all your foods containing milk allowing you to serve your customer safely.
Sulphites
• Sulphites are used as a
preservative for many dried
fruits, and to stop further
fermentation of wine, it is
sometimes used in the brewing
of beer and can be found in
many drinks.
• It only rarely causes an
anaphylactic reaction but it is
classed as major allergen as it
affects many people, including
those with asthma. This may be
because it produces an acid and
may cause breathing difficulties.
Sulphites are frequently found in the
following foods:
• Baked foods
• Soup mixes
• Jams and other preserves
• Canned vegetables
• Pickles and chutneys
• Shrimp - if treatment occurs at sea it may not be recorded
• Dried fruits such as apricots sultanas
• Cider
• Some soft drinks
• Wine and beer - except organic wine and beer
• Grape juice and several fruit juices
• Vinegar
Sulphites cont.
• Grape juice and several fruit juices
• Vinegar
• Tea
• A wide range of products and substances use sulphites as
preservatives and can have a variety of E numbers and
different names.
Tomato
• Generally an allergic reaction is to
raw tomatoes and therefore may
seem easily enough to avoid, yet it
is highly recommended that
cooked tomatoes and tomato
sauce is not given to the customer
who reacts to tomato.
• As discussed earlier, tomato in a
bolognaise sauce caused death.
This raises the question how
much must the tomato be cooked.
• This makes life complicated, and
remembers it is always best to
‘Fail Safe’.
Kiwi
• A number of people are
allergic to this fruit and
interestingly there is crossreactivity with latex and to
other foods including,
avocado, banana and
carrots .
• This shows how cross
reactivity can result in what
appears to be very different
items, but the similarity of
the protein molecules cause
the problem.
• Kiwi
Chickpeas
• In India where chickpeas are a
staple food, chickpea allergy is
increasingly significantly.
• A problem with identifying those
allergic to chickpeas is that
chickpeas go by a number of
different names in different
languages - garbanzo, ceci, chana,
hummus and gram.
• Originally in the west it was named,
cicer after the wart on Cicero's nose
that resembled this bean.
• Again this pulse or bean is widely
used in many cuisines and mixed
into a variety dishes as well as
being ground into flour,(gram).
Rice
• As with chickpeas in India,
and peanuts in Britain and
the USA it is the easily found
ingredients that are the
cause of allergies.
• It is not surprising then that
rice allergies appear where
it is consumed most.
• Also be aware of ground rice
/ rice flour in biscuits, cakes,
puddings and as a thickener.
A wide range of allergens
• Working in an international setting you might be surprised by what
someone may be allergic to. That is why it is so important to listen to your
customer and make sure that you have properly understood what they
tell you.
• You are aware that many foods can cause allergic reactions, the safest
way to look at this problem is to accept that water has never caused an
allergic reaction. This means that any food can cause an allergic
reaction, but for practical reasons of the hospitality business we focus on
the 14 most common allergens, and always listen to our customer, very
seriously no matter how strange their allergy may sound.
• In this section you have learnt about many different allergens and where
they are found. You have understood that allergens are contained in
processed foods and sauces, these are called "hidden allergens".
• Therefore you must build a list of all the allergens in your kitchen as part
of your Hazard Analysis. You will see how this is done in the next section
and how you will prepare food that free of a particular allergen or
allergens.
Module 2 Key points and revision
1. EU Legislation lists 14 allergens – can you name them?
2. What other allergens or intolerances have you come
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across?
What are hidden allergens? Give some examples
What is the difference between food allergy and food
intolerance?
What is Cross Reactivity?
If someone is allergic to peanuts they may also be
allergic to……………………
What is the purpose of sulphites in food and drinks.
Which people are most likely to react to sulphites?
Module 2 Key points and revision
8. What is the allergen commonly found in flour called.
What is the name of the illness related to this
9. Where may traces of fish or shellfish be found without
it being obvious?
10. Which popular garnishes used on food could be
allergens.