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.
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).
Every year approximately 10 people die from an allergic reaction to food.
A food intolerance is simply 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, however, affect a sufferer’s long-term health and well-being.
There is one exception to the above guidance and this involves a condition called Coeliac disease, which is an intolerance to a substance called gluten, found in wheat, rye and barley.
Coeliac disease is a condition that causes an inappropriate response by the sufferer’s immune system causing an attack on healthy cells.
Gluten triggers a reaction which damages the lining of the small intestine and disrupts the body’s ability to absorb nutrients from food, causing serious long term health problems.
Oats can also be problematic for sufferers of the disease as they are often milled in manufacturing plants which process wheat, barley and rye and cross-contamination is a serious threat.
Because coeliac disease is classed as a food intolerance, the body does not normally react in the same way as an allergenic reaction; there are no sudden, adverse reactions and the condition is often undiagnosed or misdiagnosed as different digestive conditions. Sometimes it can take a sufferer years before it is correctly diagnosed.
Thankfully, there are now many products available without gluten and many manufacturers have already removed gluten from their ingredients. You will often see this highlighted on food products. As a food manufacturer you will need to implement strict control systems to avoid cross-contamination. We will discuss this later in the course.
Approximately 1 in a 100 people are affected by coeliac disease. Coeliac UK provide extensive information on the condition.
Point to Consider: Many people mistakenly think the terms food allergy and food intolerance mean the same thing. Food intolerance (e.g. lactose intolerance), unlike a food allergy, does not involve the immune system and is not life-threatening. You need to make sure you and your colleagues understand the difference.
Symptoms of an Allergic Reaction
When someone has an allergy, they can have many different physical reactions when they are exposed to 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 constricting of the airways
- Severe asthma
- Anaphylactic shock
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 for example, 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.
As previously mentioned, approximately 10 people every year die from an allergic reaction to food. In addition, there are more worrying concerns as the number of people admitted to hospital due to food allergies and food intolerances is steadily increasing, and the reasons behind this increase are still unclear.
During 2011, almost 4,500 people were admitted to hospital suffering from a food allergy and approximately 8,500 people were admitted due to food intolerance. Admission to hospital because of a food allergy is usually as a result of anaphylaxis and 4,500 admissions means on average, there are over 12 food allergy attack incidents a day requiring hospitalisation, which is disturbingly high.
In addition to these statistics, the majority of reactions caused by food allergies and food intolerances are often self-managed or are treated in Accident and Emergency departments, and as a result, the true number of cases could potentially be much higher. It is also believed that many admissions to hospital with asthmatic reactions are thought to be induced by food allergy reactions.
Any person who claims to suffer allergic reactions must be taken seriously and as an industry, collectively have a moral and legal duty to protect the customers we serve.
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 suffers 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 great way of re-assuring allergy sufferers and proving you run or 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 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 contains and more importantly add this 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 then to highlight hidden allergens where needed.
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. You need to be careful when detailing finished dish ingredients as some of the key building blocks can contain hidden ingredients.
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