Allergens in Foodservice
In foodservice we often encounter patients with various allergies ranging from the common shellfish, nut, egg, and milk variety to the more bizarre such as lettuce, kiwi, celery, etc. It would seem that allergies are on the rise- you might have noticed higher reports of allergies among your patients or patrons. In the US, there are thirty-thousand ER visits for food related allergies annually; with approximately 150 fatalities. In the US, the Centres for Disease Control and Prevention found a 50% increase in the prevalence of allergies in children between 1997 and 20111. Better diagnosis’ may partly explain the increase.
The results of the SCAAALAR (Surveying Canadians to Assess the prevalence of common food Allergies and Attitudes towards food Labelling and Risk) study led by McGill and McMaster Universities, supported by Health Canada and AllerGen, were published in 20102. The “objective of the SCAAALAR study was to determine the prevalence of peanut, tree nut, fish, shellfish, and sesame allergy in Canada. The allergens that the study looked at are largely responsible for the majority of severe/fatal anaphylactic reactions.” 2 The research found that 7.5% (1 in 13) of children and adults have at least one food allergy3. Susan Elliot, the dean of applied sciences at the University of Waterloo, noted that approximately 30% of people when asked will report an allergy, which is not in line with the findings of the SCAAALAR study3.
Allergies need to be taken seriously and risks can not be taken that would jeopardize an individual’s health. You may come across individuals who say they do not eat a particular food, gluten for instance, and it may be due to celiac disease (affecting 1% of the North American population) or the reason being the latest fad diet. Until it is confirmed as an allergy it must be taken as one.
To clear things up let us distinguish between a few terms: allergy, intolerance, and sensitivity. Allergies are adverse immune reactions to food, medication and insect stings that can have fatal consequences. The focus of allergens for the sake of this post will be food-related allergens. In Canada there are 9 priority allergens which includes: peanuts, tree nuts (almonds, Brazil nuts, cashews, hazelnuts, macadamia nuts, pecans, pine nuts, pistachio nuts, and walnuts), sesame seeds, milk, eggs, fish (including shellfish and crustaceans), soy, wheat, and sulphites4. The following is a list of allergic responses:
- Trouble breathing, speaking, or swallowing
- A drop in blood pressure, rapid heartbeat, and/or loss of consciousness
- Flushed face, hives or a rash, or red and itchy skin
- Swelling of the eyes, face, lips, throat, and tongue
- Anxiousness, distress, faintness, paleness, sense of doom, and/or weakness
- Cramps, diarrhea, and/or vomiting3
In contrast, an intolerance does not lead to death, although some of the responses can be similar. It usually takes a normal amount of food to cause a reaction where as a minute amount of food can lead to an allergic reaction. Intolerances involve the gastrointestinal tract more often4.
Lastly, a sensitivity as reported by Health Canada “is an adverse reaction to a food that other people can safely eat, and includes food allergies, food intolerances, and chemical sensitivities.” 4 A chemical sensitivity is an adverse reaction to naturally present chemicals or additives; examples include caffeine in coffee, tyramine in aged cheese and MSG as a flavour enhancer4.
Food service requires us to provide food within mandated standards while balancing costs. Add to the equation therapeutic diets (diabetic renal, heart healthy, pureed), patient preferences and allergies. At times the variety (or lack of) can be limiting to a handful of meal options given multiple dietary restrictions. Adapting to patient needs will vary with the operation, some organizations may use preassembled meals which are fixed (all entrée components are pre-portioned together) where as others may be able to adjust or introduce new recipes in-house (cook-chill for example). Going forward, I believe organizations will need to provide a diverse and easily modular menu to keep up with the increasing prevalence of allergies, preferences, and therapeutic diets in North America.
Allergies are incredibly serious and must be treated as such. Let us not become jaded by the boy who cried wolf. Let us not perceive allergens as less because of those who have willingly jumped aboard the fad diet train. As a diet tech I have come across a variety of allergies. From celery to kiwi, lettuce to coffee. With prying, some allergies turn out to be intolerances. I have also worked in foodservice as a cook at a pasta station. Patrons would request the gluten-free pasta due to “an allergy” but would request the béchamel sauce (made with flour) and a side of garlic bread.
You have probably taken note of patients/patrons who report an allergy but are actually without one or instead have an intolerance to that food. We see individuals who generally fall into one of the following camps:
- Well educated about their allergies and medically diagnosed
- jump on the latest exclusion diet to lose weight (such as gluten-free)
- has a food intolerance not an allergy, but does not know the difference
It is a challenge that will need to be dealt with using tact and patience. Until Electronic Health Records are able to provide universally accessible and comprehensive medical information, allergies will need to be thoroughly screened. Designing menu’s that are modular and easily adapted (perhaps more for scratch cooking) could be of great value. Checking updated manufacturers ingredient list’s is good practice for any food service operation. And lastly, asking the right questions during screening to differentiate between allergy, intolerance, sensitivity, and preference.
