Introduction

In this course we decided to firstly explain the law so you can appreciate what has changed and why you need to understand these changes.  It is now time to consider what exactly a Food Allergy is, and what happens to the body during a food allergy attack. 

Food Allergy

A food allergy attack occurs when the body’s immune system, which normally works to protect the body, mistakenly attacks a food protein. The body sees the certain food protein as a threat and attempts to defend itself, sometimes with fatal consequences.

Allergic reactions to foods vary in severity and can be potentially fatal. Symptoms may include stomach upsets, rashes, eczema, itching of the skin or mouth, swelling of tissues (e.g. the lips or throat) or difficulty in breathing (more on symptoms later).

Food Intolerance

Food intolerance is the body’s inability to digest a particular food, which is why it is important to be aware of common types of food intolerance, such as lactose intolerance.

Symptoms of food intolerance can be similar to those of a food allergy and can include abdominal cramps, bloating and diarrhoea. However, unlike a food allergy attack, food intolerance does not involve the immune system and is not life-threatening. Food intolerances can badly affect a sufferer’s long-term health and well-being.

There is one exception to the above guidance, a condition called Coeliac disease, which is an intolerance to a substance called gluten, found in wheat, rye and barley. We discuss Coeliac disease in further detail in Chapter 3.

Symptoms of an Allergic Reaction

When someone has an allergy, they can have many different physical reactions when they are exposed to certain allergens.

The type of reaction and the severity will depend on the individual and the severity of their allergy. Very small amounts of some allergens, such as nuts, can cause severe adverse reactions including potentially fatal anaphylactic shock.

Typical reactions can include:

• Flushing of the skin
• Skin rashes and hives that can be severe and last for several weeks
• Abdominal pain, diarrhoea or constipation
• Nausea and/or vomiting
• A sudden fall in blood pressure causing weakness, dizziness and even unconsciousness
• Swelling of the throat and tongue
• Difficulty in breathing and swallowing due to tightening airways
• Severe asthma
• Anaphylactic shock
• Death

Anaphylaxis

Anaphylaxis is a serious and potentially life-threatening allergic response to ingesting a certain food allergen. The sufferer will experience swelling, hives, lowered blood pressure and dilated blood vessels. In severe cases, the person could go into Anaphylactic Shock, which can be fatal.

Anaphylaxis occurs when the immune system develops a specific allergen fighting antibody that creates an exaggerated reaction towards a substance that is normally harmless, like food.

The person may experience itching and redness of the eyes or face, followed by swelling of the throat and difficulty breathing. This can quickly progress into an anaphylactic shock as the heart rate increases, a sudden drop in blood pressure, resulting in unconsciousness and ultimately death.

Potentially minute quantities of an allergen can have a profound effect on the sufferer. Some people have such a serious response that they can die in a matter of minutes.

You may have been on an aeroplane where the captain announces that they have a person with a severe nut allergy. They will stop serving peanuts, and ask that all passengers refrain from eating any nut-based products. The reason is that even the smallest traces of dust from a nut can cause a severe reaction which is unimaginable if an incident happens at 35,000 feet with no access to the emergency services.

Anaphylactic attacks are particularly distressing to the sufferer and anybody who is with the person. The need for a calm and quick reaction to the attack is vital and we will discuss this in the final chapter.

People who are in danger of such severe reactions will normally carry an EpiPen, which is a rapid injector of adrenaline that can help prevent the anaphylactic shock from becoming fatal. Again, we will discuss this in the final chapter.

Emergency treatment

For full details and to watch an instructive video, click on the Anaphylaxis Campaign link to walk you through a step-by-step response.

If you suspect anyone is having an anaphylactic shock, you must:

1. Administer EpiPen (adrenalin dispenser prescribed by GP) as soon as possible when a severe reaction is suspected.
2. Keep the person as still as possible. Ideally, they should be lying down and if they are feeling weak, dizzy or appear pale and sweating their legs should be raised.
3. Call 999. Advise the person is suffering from anaphylaxis. Give clear and precise directions to the operator, including your postcode.
4. Make note of the time the adrenaline was given. If there is no improvement, a second dose can be given after 5 minutes.
5. If the person deteriorates after making the initial 999 call, make a second call to ensure an ambulance has been dispatched.
6. Send someone outside to direct the ambulance crew.
7. Try to find out what food or substance caused the reaction and ensure the ambulance crew knows this.

Key Statistics for the UK

• The UK has some of the highest prevalence rates of allergic conditions in the world, with over 20% of the population affected by one or more allergic disorders. (M. L. Levy, 2004)
• A staggering 44% of British adults now suffer from at least one allergy and the number of sufferers is on the rise, growing by around 2 million between 2008 and 2009 alone. Almost half (48%) of sufferers have more than one allergy - that is around 10 million people (Foods Matter, 2010)
• The least likely to suffer from allergies are pensioners - with a 30% allergy rate among this group whereas women and younger adults (under 35) are the most likely to claim an allergy - around 50% (Foods Matter, 2010)
• In the 20 years to 2012, there was a 615% increase in the rate of hospital admissions for anaphylaxis in the UK (Turner PJ, 2015)
• The percentage of children diagnosed with allergic rhinitis and eczema have both trebled over the last 30 years (Gupta R, 2007)
• Between March 2013 and February 2014 there were a total of 20,318 finished admission episodes (FAEs) with a primary diagnosis of an allergy. This represents a 7.7% increase from 18,862 for the previous 12 months. (HSCIC, 2014)
• In the same year, 19.2% of emergency admissions were for anaphylactic reactions and 19.2% were for ‘Other’ allergic reactions. The lowest number of emergency admissions was for allergic rhinitis (1.0%). (HSCIC, 2014)
• In the UK, allergic diseases across all ages cost the NHS an estimated £900 million a year, mostly through prescribed treatments in primary care, representing 10% of the GP prescribing budget. (Venter, 2009)
• Almost a third of allergy sufferers have had to change their lifestyles to reduce their allergic reactions. Actions range from keeping their home extra clean (11%) to using special bedding (11%) (Foods Matter, 2010)

Avoiding Allergic Reactions

The exact causes of allergic reactions and food intolerance are still unknown, so avoiding the offending food is currently the only way to manage the condition.

Most sufferers are aware of their allergies and will be very careful when ordering and eating food ‘out of the home’.

If they are uncertain or doubt the information you provide, they will usually avoid any dish that has the potential to harm them. However, as we have mentioned in the previous chapter, it is now your legal responsibility to be clear about ingredients and to be able to answer any question confidently and accurately. NEVER ASSUME OR GUESS - YOU COULD KILL SOMEBODY.

Our suggestion to have a folder containing all recipe information is a great way of reassuring allergy sufferers and proving you work for a professional, well-run business that cares for its customers. Ignorance of the facts is not a due diligence defence and will seriously harm your business.

Hidden Allergens

Hidden allergens are probably the biggest threat to food safety and you MUST take care when developing a dish or using an ingredient in a finished product.

When adding an ingredient, carefully read the ingredient declaration panels. You may not want to change or remove the ingredient from your dish, but you need to understand which hidden allergens it may contain and more importantly, add it to your recipe list and make sure all staff are aware.

Increasingly, manufacturers are removing allergenic ingredients from their products, however, it remains your responsibility to make sure you have read the ingredients from any supplier and highlighted the hidden allergens.

Examples of hidden ingredients in commonly used products:

• Celery in stock cubes
• Mustard in stock cubes, curry pastes/sauces, Thai pastes/sauces
• Fish, (anchovies) in Worcestershire sauce, special fried rice
• Shellfish in special fried rice
• Milk in cheese, (lactose) in potato snacks/crisps, yoghurt, butter, cream
• Nuts in Indian curry pastes/sauces, Thai pastes/sauces, cooking oils, bread
• Soya in cooking oil, soy sauce
• Eggs in pastry, pastry glaze
• Sulphites in ham, preservatives, white wine
• Gluten in pastry, pizza bases, pasta such as lasagne sheets, wheat starch, stock cubes, and Worcestershire sauce

Hidden Allergens - Beef Stock Cubes

A perfect example of a hidden allergen can be found in one of the most widely used products in the foodservice industry, beef stock cubes and beef bouillon:

Ingredients: Salt, Vegetable Fats, Potato Starch, Sugar, Beef Extract, Yeast Extract, Flavourings, Onion Powder, Colour (Plain Caramel), Maltodextrin, Parsley Leaves, Carrot, Spices (Parsley Roots, Celery Seeds), Dextrose

Whilst most stocks are now gluten and lactose-free, they tend to include celery as an ingredient. So be careful when detailing finished dish ingredients as some of the key building blocks can contain hidden ingredients.

Learning outcomes

By the end of this chapter you should have developed the following understanding and insights:

• An understanding of the terms food allergy, food intolerance and Coeliac disease
• An awareness of the symptoms of an allergic reaction (anaphylactic attack)
• An awareness of the concept of hidden allergenic ingredients incl practical examples