FOOD ALLERGENS

At least one third of all adults believe they have some sort of a food allergy, but true food allergies affects less than 2% of the population. Only five percent of young children are diagnosed with food allergies and many of those outgrow them by the time they reach adulthood.

To a small percentage of the population, food allergies can be fatal. In 1993, three Rhode Islanders died as a result of allergic reactions to food; in two cases, the deaths resulted from foods prepared in commercial food establishments. The individuals did not know they were eating foods to which they were allergic.

FDA believes there is scientific consensus that the following foods can cause serious allergic reactions in some individuals and account for more than 90 percent of all food allergies:

• Peanuts
• Soybeans
• Milk
• Eggs
• Fish (including crustacean)
• Tree nuts
• Wheat
  

A food allergy is a violent reaction to an otherwise harmless food that involves the body’s immune system. An allergen is any substance that produces an allergic reaction.

Allergic reactions can begin within minutes to a few hours after eating the problem food. However, in very sensitive individuals, just touching or smelling the food can result in an allergic reaction.

Most often, but not always, the symptoms of an allergic reaction begin with: a sensation that the lips and tongue are swelling; itching or tingling in the mouth; sensation of warmth; redness to the skin, hives; tightness in the throat; eyes may itch, water and swell; nausea, vomiting, cramping, diarrhea. Anaphylaxis occurs when several parts of the body have food-allergic reactions at the same time. This condition is rare, but can be fatal.

Symptoms of food allergy vary among individuals as to the severity, when they begin and the amount of food that is eaten. The same food can produce different reactions in different people and different foods can cause the same reaction in one person. Individuals with asthma appear to be at greater risk of food allergies.

Diagnosing and managing a food allergy requires medical treatment. Once the food allergy is confirmed through an examination including a complete medical history and a series of specialized tests, the only proven treatment is to avoid the offending food.

To eliminate the offending food from the diet it is necessary to read and understand food ingredient labels. By law, a list of ingredients in each food product should be listed on the label. Labels should be re-checked regularly as the ingredients in products change. Specific information about the ingredients is available from the company producing or processing the food product.
In August 2004, the Food Allergen Labeling and Consumer Protection Act (Public Law 108 282, Title II) was enacted, which defines the term “major food allergen.” The definition of “major food allergen” adopted for use in the Food Code (see paragraph 1 201.10(B)) is consistent with the definition in the new law. The following requirements are included in the new law:

• For foods labeled on or after January 1, 2006, food manufacturers must identify in plain language on the label of the food any major food allergen used as an ingredient in the food, including a coloring, flavoring, or incidental additive.
• FDA is to conduct inspections to ensure that food facilities comply with practices to reduce or eliminate cross-contact of a food with any major food allergens that are not intentional ingredients of the food.
• Within 18 months of the date of enactment of the new law (i.e., by February 2, 2006), FDA must submit a report to Congress that analyzes the results of its food inspection findings and addresses a number of specific issues related to the production, labeling, and recall of foods that contain an undeclared major food allergen.
  

Within 2 years of the date of enactment of the new law (i.e., by August 2, 2006), FDA must issue a proposed rule, and within 4 years of the date of enactment of the new law (i.e., by August 2, 2008), FDA must issue a final rule to define and permit the use of the term “gluten-free” on food labeling. (2005 FDA Food Code, Annex 4, p 483).

Foodservice establishments have a responsibility to provide correct and up to date information about food items on the menu. “Secret” ingredients, which are considered allergens such as peanuts, nuts, eggs, milk, shellfish and fish, should not be used in any food items.

Waitstaff should take customer inquires about allergies seriously. They should be familiar with all the ingredients in the food items on the menu and how they are prepared. For example, waitstaff should know the ingredients in a batter used to bread meats or fish. If the ingredients change, they should be advised of the change.

Avoid cross contamination during preparation of food items. Cross contamination is the transfer of one food ingredient to another food ingredient by a food contact surface (i.e. human hands, cooking utensils). An individual had an allergic reaction when he ate a sandwich that had been made with a knife that had been used to make a peanut butter sandwich.

If a patron has an allergic reaction, respond quickly. Ask if there is a history of food allergies and check for a medical bracelet or necklace. In Rhode Island, the majority of individuals with this problem carry a syringe loaded with epinephrine (Epi Pen) that can be easily injected. Call 911 for immediate medical assistance. The sooner the reaction is treated, the less sever it will be. People have died because they have disregarded their symptoms.

Persons sensitive to these specific allergens should avoid the following foods/ingredients:

Eggs

• Albumin
• Egg (including whites and yolk)
• Eggnog
• Mayonnaise and other dressings
• Ovalvumin
• Ovomucoid
• Simplesse
• Egg-based glaze on baked goods

Fish

• Anchovy (including anchovy paste)
• Caviar
• Fish byproducts
• Imitation crab (surimi)
• Roe
• Oil used to fry fish would case a reaction

Milk

• Cream
• Curds
• Dry milk solids
• Lactalbumin, lactalbumin phosphate
• Lactose
• Milk (derivative, protein, solids)
• Artificial butter flavor
• Butter, butter fat
• Buttermilk
• Casein, rennet casein
• Cheese
• Sour cream or milk solids
• Caseinates (ammonium, calcium, magnesium, potassium, sodium)
• Whey (delactosed, demineralized, protein concentrate)
• Yogurt

Peanuts

• Cold pressed peanut oil
• Mixed nuts
• Nu-nuts® flavored nuts
• Peanut butter
• Peanut flour
• Foods containing peanut protein including:
  • Chinese and Thai dishes - egg rolls
  • Baked goods-pastries, cookies, danish
  • Candy
  • Chili
  • Marzipan
  • Soups

Tree-nuts

• Almonds
• Brazil nuts
• Cashews
• Chestnuts
• Filberts/hazelnuts
• Hickory nuts
• Giandiju (chocolate nut mix)
• Macadamia nuts
• Marzipan/Almond paste