Food Allergies in Foodservice Rotations

While being in my Institutional Food Service, Production, and Management rotation this summer, a common concern from management has come to my attention. And this concern would be…  Food Allergies!

A food allergy is the body’s immune system reaction to certain foods. Symptoms of an allergic reaction include itching or swelling in or around the mouth, face, and scalp; tightening in the throat; wheezing or shortness of breath; hives; abdominal cramps, vomiting, diarrhea; loss of consciousness; and even death.

Food allergies are a growing public health concern. As many as 15 million people in the U.S. have food allergies. An estimated 9 million, or 4%, of adults have food allergies. Nearly 6 million, or 8%, of children have food allergies with young children affected the most. Although children allergies to milk, egg, wheat, and soy generally resolve in childhood, they appear to be resolving more slowly than in previous decades, with many children still allergic beyond age 5 years. Allergies to peanuts, tree nuts, fish, or shellfish are generally lifelong allergies.

The top food allergens are categorized into eight food groups. These eight food groups account for 90% of all food-allergic reactions. They include: milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat. The estimated prevalence among the American population is:

          Milk and eggs: based on data within and obtained outside the United States, this rate is likely to be 1-2% for young children and 0.2-0.4% in the general population.

          Peanut: 0.6-1.3%

          Tree nuts (e.g., walnuts, almonds, cashews, pistachios, pecans): 0.4%-0.6%

          Fish: 0.4%

          Crustacean shellfish (e.g., crab, lobster, shrimp): 1.2%

          All seafood: 0.6% in children and 2.8% in adults

The Centers for Disease Control and Prevention reported that food allergies result in more than 300,000 ambulatory-care visits a year among children under the age of 18 years. From 2004 to 2006, there were approximately 9,500 hospital discharges per year with a diagnosis related to food allergy among children under age 18 years. Even small amounts of a food allergen can cause a reaction. Most allergic reactions to foods occurred to foods that were thought to be safe. Allergic reactions can be attributed to a form of mislabeling or cross-contact during food preparation. Food allergy is the leading cause of anaphylaxis outside the hospital setting. Every 3 minutes a food allergy reaction sends someone to the emergency department. This is approximately 200,000 emergency department visits per year, and every 6 minutes the reaction is one of anaphylaxis. Teenagers and young adults with food allergies are at the highest risk of fatal food-induced anaphylaxis. Symptoms of anaphylaxis may recur after initially subsisting and experts recommend an observation period of about 4 hours to monitor that the reaction has been resolved. Individuals with food allergies who also have asthma may be at an increased risk for severe or fatal food allergic reactions. Children with food allergy are 3-4 times more likely to have other related conditions such as asthma and other allergies, compared without food allergies. It is possible to have anaphylaxis without any skin symptoms (no rash or hives). Failure to promptly (i.e., within minutes) treat food anaphylaxis with epinephrine is a risk factor for fatalities.

Chemical contamination can occur when high-acid foods are prepared or stored in metal-lined containers. Poisoning may result if brass or copper, galvanized, or gray enamelware containers are used. Fruit juices should never be stored in gray enamelware with lead glaze or tin milk cans. Cases of poisoning have been recorded that have been attributed to use of improper metal utensils. Sauerkraut, tomatoes, fruit gelatins, lemonade, and fruit punches have been implicated in metal poisonings.

Toxin metals also have been implicated in food poisoning cases. Copper may become poisonous when it is in prolonged contact with acid foods or carbonated beverages. The vending industry voluntarily discontinued all point-of-sale carbonation systems that do not completely guard against the possibility of backflow into copper water lines. Also, food such as meat placed directly on cadmium-plated refrigerator shelves may be rendered poisonous.

Mayo Clinic

NIH

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