Food Protection Connection: Fast Facts About Food Allergy

(reprinted from Dietary Manager, October 2001)

Among the food safety challenges facing a dietary manager today is that of protecting customers from allergic reactions to food. Food allergy, estimated to affect about 1.5% of adults and 6% of children, is actually on the rise, according to FDA officials. At the same time, undeclared allergens in food routinely prompt food product recalls, as consumers eat food and experience reactions.

What it is

What exactly is food allergy? It is a condition in which an individual's immune system is sensitive to a food. Typically, it works like this:

• The tendency to develop an allergy to a particular food is generally inherited.
• The first time a susceptible individual is exposed to the food, the body produces special immune cells to the food. These stay in the system.
• Ever after, when the individual eats this food, an allergic response follows.

Common allergic responses to food include vomiting, hives, swelling of tongue or throat, gasping for breath, very low blood pressure, and even anaphylactic shock. Often, this is an emergency medical situation. Occasionally, this reaction leads to death. Symptoms of food allergy may occur immediately, or within a few hours.

The part of the food that brings on an allergic response is called the allergen. It is actually a small protein fragment that resists digestion and gets into the bloodstream after eating. For some individuals, the medical treatment for a reaction includes an immediate dose of epinephrine. This is a medicine that would be administered by a qualified medical professional.

The Culprits

According to the FDA, eight foods are the most common culprits in food allergy, although of course others can trigger allergy, too. The big eight are: shrimp, lobster, crab, other shellfish, peanuts, walnuts (or other nuts that come from trees), fish, and eggs. For very young children, the list expands to include: milk, soy, and wheat as well.

Children with allergies to these three and/or eggs often do outgrow the allergy. Determining whether a food allergy exists is best done by a qualified physician. Several tests exist for diagnosis. One is a prick skin test, in which a physician pricks a tiny amount of an allergen into the skin and watches for a reaction. Another is called a RAST test, which is a blood test that identifies antibodies to foods.

Allergy or Intolerance?

The word "allergy" is sometimes tossed about loosely. A person who drinks milk and then suffers gas, cramping, or mild diarrhea may not have an allergy at all. This may turn out to be lactose intolerance, an inability to digest the carbohydrate in milk. Any time a food causes mild gastrointestinal symptoms, this may be a food intolerance. Some people cannot tolerate spicy foods, or beans, or other products. Allergy is different, though, in that it is a true immune system response. Allergic-response chemicals are produced, such as histamine. Anyone who is unsure about food allergy or intolerance should be directed to a physician for assistance in diagnosing the problem.

Managing a Food Allergy

There is no known cure for food allergy. In adults, an allergy is not likely to disappear. Instead, it will become a lifelong concern. So, the best advice to anyone with a food allergy is to avoid the food. Sounds easy, right? Unfortunately, it's not. Yes, the Federal Food, Drug and Cosmetic Act requires manufacturers to list food ingredients on a label. However, the complexities of food processing today mean that there are many ingredients in foods that most of us do not readily understand.

For example, did you know that caseinate in an ingredient list means a milk product? Or that albumin means an egg product? Consumers with allergies have to work hard to find the alternate names for ingredients that may cause reactions. In response, the National Food Processors Association has initiated voluntary efforts to list the "big eight" allergens in plain English on food product labels.

A second and more troubling problem relates to undeclared and unintended allergens in processed foods. This is the situation that has led to recalls. Products recalled just in the early days of September 2001 for undeclared allergens include:

• animal crackers sold in 12 states — for presence of undeclared milk and egg products
• a frozen broccoli/cheese product sold in Pennsylvania — with undeclared eggs
• a turkey product — with undeclared milk
• a crab product — with undeclared egg whites.

A recent FDA study conducted in Wisconsin and Minnesota revealed that 25% of food products tested contained allergens not identified on labels. Often, this occurs unintentionally, through incomplete cleaning routines. It's a type of cross contamination. Instead of passing harmful bacteria from food to food through equipment, manufacturers are passing allergens from food to food, as traces of foods previous processed remain on equipment. In response, the FDA has boosted educational efforts among both manufacturers and consumers.

Advice for Managers

Are you wondering how to protect your customers? Clearly, as a dietary manager, there are steps you can take — and a few things that are out of your immediate control. What you can do is:

• Clearly label the foods you serve, with special attention to common allergens.
• Review labels of ingredients you use, to be sure you know if they contain common allergens.
• In clinical care, identify food allergies of residents/patients, and be sure you honor these.

What you cannot do is control the problem of mislabeling or undeclared allergens. However, you can check recall information on the Web at www.fsis.usda.gov/Fsis_Recalls/index.asp and keep up with known problems as they arise.

By Sue Grossbauer