1. SERVING GUESTS WITH SPECIAL HEALTH NEEDS Food Allergies Chapter 13 1

2. Learning Objectives  Differentiate food allergies, intolerances and aversions  Describe the symptoms of a food allergy  Describe importance of eliminating allergens from a patrons food  Discuss prevention of cross contamination in kitchens  Identify ways the patron can assure allergen free foods  Describe how to identify and find allergens on a food label  Identify the most common allergens and at least 10 foods that include each of them 2

3. Food Allergies and Intolerances Food AllergyA food allergy occurs when a food protein is attacked by the immune system. This attack triggers a sudden release of histamine, among other chemicals, and results in allergic reaction symptoms Food Intolerance A food intolerance is characterized by unpleasant symptoms, such as stomach cramps or diarrhea that occur after consuming certain foods. People with a food intolerance can eat minimal amounts of the food in question without experiencing major symptoms. The amount of food tolerated varies greatly from person to person Food AversionA food aversion is neither an allergy nor intolerance. It is an intense dislike that may cause a biological response (nausea). Aversions usually have psychological and/or physiological causes or effects. Many aversions are based what foods are acceptable within one's culture 3

4. Food Allergies  Affects about 4% of children  Affects about 1% to 2% of adults  About 12 million Americans have food allergies  Immune system-antibody response to protein(s) in foods  Symptoms  Mild to severe  Usually occur immediately, up to 2 hours after ingestion  More severe with each exposure to allergen 4

5. Common Symptoms  Skin  Rash, hives, itching, swelling, watery eyes  GI  Vomiting, cramping  Respiratory  Trouble breathing, wheezing, runny nose  Anaphalaxis Airways close, unable to breathe Death  Cardiovascular  Rapid heart rate  “The Peanut Reaction”  http://www.youtube.com/watch?v=31hptHYscX4 http://www.youtube.com/watch?v=31hptHYscX4

6. 8 Most Common Allergens  90% of food allergies  Milk  Eggs  Peanuts  Tree nuts  Fish  Shellfish  Wheat  Soy 6

7. Food Allergies  Tiny traces of an allergen can trigger reactions  Often, a potential allergen is not obvious or recognizable in foods  Restaurants and Food Allergies  http://www.youtube.com/watch?v=Oa74l_ogZac http://www.youtube.com/watch?v=Oa74l_ogZac 7

8. Food Allergies – Cross-contamination  Cross-contamination is one of the leading causes of food allergy reactions in restaurants  Clean utensils and work surfaces thoroughly before preparing food for allergic guest  Aware of cutting boards, slicers, other kitchen equipment that may have been used before  Traces of egg, flour or nuts may adhere to rubber gloves, parchment paper or a spatula 8

9. Key Points- Food Allergies  Complete avoidance of allergenic ingredient is critical  Read food labels, particularly ingredient lists  Encourage diners with allergies to call ahead, confirm accommodations, pre-order, so the chef can check ingredients, use appropriate equipment  Chef/restaurant employees should understand importance of ingredients, communication of food allergy  Creative adjustments i.e adding a bit of flour to thicken or butter to enrich can cause a dangerous reaction 9

10. Allergen Labeling The Food Allergen Labeling and Consumer Protection Act (FALCPA) of 2004 The label of a food that contains an ingredient that is or contains protein from a major food allergen declare the presence of that allergen

11. Allergens on the Food Label  Ingredient list or:  The word “Contains” followed by the name of the major food allergen  A parenthetical statement in the list of ingredients – for example, “albumin (egg)”  Allergenic ingredients must be listed if present in any amount, even in colors, flavors or spice blends.  Manufacturers must list the specific nut (almond, walnut, cashew) or seafood (tuna, salmon, shrimp, lobster) used  Gluten is not included in FALCPA 11

12. Milk Allergy: Dairy Products to Avoid  Acidophilus milk  Butter  Buttermilk  Cheese  Cheese food  Coffee creamer  Condensed milk  Creamed soups  Custards  Evaporated milk  Ice cream  Margarine containing milk solids  Milk chocolate  Puddings  Sour cream  Whipped cream  Whole, skim, and low- fat milk  Yogurt 12

13. Milk Allergy: Ingredients to Avoid  Ammonium caseinate  Binding agents  Butter flavorings  Calcium caseinate  Caramel or caramel flavorings  Carob  Casein  Casein hydrolysate  Ghee  Lactalbumin  Lactate  Lactic acid  Lactoferrin  Lactoglobulin  Lactulose  Malted milk  Milk protein  Non-dairy creamer may contain casein  Nougat  Protein hydrolsate  Rennet casein  Simplesse™  Skim milk solids  Sodium caseinate  Whey  Whey protein hydrolysate 13

14. Milk Allergy: Foods Commonly Containing Milk Products  Baked goods, cakes, cookies  Biscuits  Bread  Breakfast cereals  Butter, alone, in or on foods  Candy, fudge, milk chocolate, caramels  Canned tuna, some brands contain casein  Cheese  Cocoa mixes  Crackers and cereals  Cream sauces  Custard  Deli meats, cold cuts with casein as binder  Egg substitutes  Foods fried in batter  Gravies  Ice cream  Instant drink mixes  Instant potatoes  Hot dogs (unless kosher)  Margarine  Mayonnaise  Pancakes, waffles  Salad dressings  Sausages  Sherbet  Soups  Sour cream  Soy/vegetarian cheese  Specialty coffees, latte, cappuccino  Tofu  Vegetables in cream or cheese sauces  Whipped toppings 14

15. Milk Allergy Tips for chefs  Have soymilk, rice milk or almond milk in the kitchen to substitute for cows' milk  Use vegetable oil instead of butter when possible  Offer a tapenade or hummus as a spread for bread instead of butter  Kosher foods marked pareve, are acceptable with meat meals, thus contain no milk or dairy products 15

16. Egg Allergy: Terms That Imply Egg Protein is Present  Albumin  Globulin  Lecithin  Livetin  Lysozyme  Simplesse ™  Vitellin  Words starting with "ova" or "ovo," such as ovalbumin or ovoglobulin 16

17. Egg Allergy: Foods and Ingredients to Avoid  Angel food cake  Cholesterol-free egg substitutes (usually contain egg whites)  Cream pies  Custard  Eggs, egg whites, egg yolks  French toast  Hollandaise sauce  Mayonnaise  Meringue  Pancakes  Puddings  Soufflés  Surimi 17

18. Egg Allergy: Foods Commonly Containing Eggs  Baked goods, muffins, rolls, cakes  Béarnaise sauce  Beer  Breaded or battered foods  Breads, such as challah or others with egg in the dough or an egg glaze  Broth (clear), consommé or stock clarified with eggs  Casseroles made with eggs  Cream-filled chocolates  Cookies  Custard  Divinity and fondant  Foam in milk toppings on specialty coffee drinks  Fried food (with eggs used in the batter)  Fudge  Ice cream  Jelly beans (some)  Marshmallows  Marzipan  Mayonnaise-containing products  Meat loaf, meatballs  Newburgh sauce  Nougat  Pastas  Pretzels  Root beer  Salad dressings  Sausages (some)  Sherbet  Sweet rolls and pie crusts (with egg glaze)  Tartar sauce  Wine (some are clarified with egg) 18

19. Replacing Eggs in Recipes 19 If the eggs are used for leavening For 1 egg use:  1½ tablespoons liquid + 1½ teaspoons oil + 1 teaspoon baking powder  1 teaspoon baking powder + 1 tablespoon liquid + 1 tablespoon vinegar  1 teaspoon yeast + ¼ cup warm water  ½ teaspoon baking powder + 2 tablespoons liquid  2 tablespoons flour + 1.2 tablespoons shortening + ½ teaspoon baking powder + 2 tablespoons liquid

20. Replacing Eggs in Recipes 20 If the eggs are used as a binder For 1 egg use:  1 packet of plain gelatin + 2 tablespoons warm water  1 tablespoons of fruit puree  1/3 cup of water blended with 1 tablespoon of flax seeds (for 1 egg)  Soft tofu

21. Peanut Allergy 21 Direct contactThe most common cause exposure is eating peanuts or peanut- containing foods. Sometimes direct skin contact with peanuts can trigger an allergic reaction Cross contactThe unintended introduction of peanuts into a product is generally the result of exposure during processing or handling of a food product InhalationAn allergic reaction may occur if dust or aerosols containing peanuts is inhaled – for example, peanut flour or peanut oil cooking spray Peanuts are not actually nuts; they are legumes. Also known as groundnuts or monkey nuts Exposure can occur in three ways:

22. Peanut Allergy: Ingredients to avoid  Peanuts  Peanut oil  Peanut butter 22

23. Peanut Allergy Foods Commonly Containing Peanut  African, Chinese, Indonesian, Thai, Vietnamese and Mexican dishes (Thai dipping sauces, salads, pad Thai, etc.)  Sauces, such as pesto, gravy, mole sauce and peanut sauce  Artificial nuts (peanuts reflavored as pecans or walnuts)  Nuts roasted in peanut oil  Baked goods  Chocolate candy and peanut brittle  Egg rolls  Foods that contain extruded, cold-pressed or expelled peanut oil, which may contain some peanut protein  Ice cream  Salad dressing  Seeds, such as sunflower seeds and soy nuts made or processed on equipment shared with peanuts  Some vegetarian and vegan food products, especially those sold as meat substitutes  Sweets, such as puddings, cookies and hot chocolate 23

24. Tree Nut Allergy  Almonds  Beech nut  Brazil nuts  Cashews  Chestnuts  Coconuts  Ginko nut  Hazelnuts/Filbert  Hickory nuts  Lichee nut  Macadamia nuts  Pecans  Pinenuts  Pistachios  Walnuts 24

25. Tree Nut Allergy  Most people allergic to tree nuts are also allergic to peanuts  Water chestnuts are actually part of a plant root and are not nuts. They, like nutmeg, are safe for someone allergic to tree nuts 25

26. Tree Nut Allergy Foods Commonly Containing Tree Nuts  Barbecue sauce  Breading for chicken or fish  Cereals  Chocolate candy  Cookies and desserts  Crackers  Fois gras ( sometimes pistachios)  Honey and chestnut honey  Mandelonas (peanuts soaked in almond flavoring)  Meat-free burgers  Mexican coffee (uses pinon)  Mortadella (may contain pistachios)  Natural flavorings and extracts (pure almond extract)  Nut butters, nut oils  Nut-flavored coffee/liqueurs (Amaretto, Frangelico®)  Pancakes  Piecrust, some pies and tarts  Salads and salad dressings  Spreads - almond paste, chocolate nut, nougat, Nutella®, nut paste 26

27. Fish Allergy  Fish and shellfish allergies tend to be severe  Fish protein can become airborne during cooking  People who are allergic to fish should avoid seafood restaurants because of the risk of contamination of non-fish meals 27

28. Fish Allergy: Foods to Avoid  All fish with fins and scales  Bass  Flounder  Cod  Salmon  Tuna  Halibut 28

29. Fish Allergy: Foods Commonly Containing Fish  Asian fish-based sauces  Barbecue sauce (some are made from Worcestershire)  Bouillabaisse, chowder, gumbo, Jambalaya and cioppino  Caesar salad (may contain anchovies in the salad of dressing)  Caponata and sweet/sour relishes that may contain anchovies  Imitation fish or shellfish (surimi)  Meatloaf and meatballs (may contain Worcestershire sauce)  Salad dressings  Steak sauce  Surimi  Worcestershire sauce 29

30. Shellfish Allergy  Shellfish allergy is one of the most common and severe food allergies  Those with shellfish allergy may have an allergic reaction to only certain kinds of shellfish or may be allergic to all varieties  People with shellfish allergies are often sensitive to iodine as well  Nori rolls and other seaweeds contain high levels of iodine 30

31. Shellfish Allergy Common Allergy-causing Shellfish  Crustaceans  Crabs  Crayfish  Lobster  Langoustines  Prawns  Shrimp  Mollusks  Bivalves  Clams  Mussels  Oysters  Scallops  Gastropods  Limpets  Periwinkles  Snails (escargot)  Abalone  Cephalopods  Squid  Cuttlefish  Octopus 31

32. Wheat Allergy  People who are allergic to wheat have a specific intolerance to wheat protein  This allergy is not the same as gluten intolerance (celiac disease)  Many wheat-allergic children outgrow this allergy  For those with wheat allergy, alternative grains such as quinoa and rice should be offered 32

33. Wheat Allergy Foods and Ingredients to Avoid  All-purpose flour  Bread (unless wheat-free)  Bran  Breadcrumbs  Bulgur  Cake flour  Cracked wheat  Durum flour  Enriched flour  Gelatinized starch  Gluten  Graham flour  Kamut®  Miller’s bran  Modified food starch  Pastry flour  Semolina  Spelt  Starch  Vegetable gum  Wheat germ  Whole-wheat flour 33

34. Wheat Allergy Foods Commonly Containing Wheat  Beer  Bouillon base and cubes  Breads (many corn or rye breads also contain some wheat flour) and rolls  Breakfast bars  Breakfast cereals  Candy  Cakes and muffins  Coffee substitutes  Condiments, such as ketchup  Couscous  Cookies  Dairy products, such as ice cream  Deli meat products, cold cuts and sausages  Farina  French fries  Gelatinized starch  Hot dogs  Hydrolyzed vegetable protein  Ice cream  Imitation crabmeat  Malt  Meat, crab or shrimp substitutes  Modified food starch  Natural flavorings  Noodles  Pancakes, pancake and waffle mixes  Pasta  Processed meats  Sausage  Soup mixes  Soy sauce  Tempura batter  Vegetable gum  Waffles  Wheat germ  Wheat starch 34

35. Soy Allergy: Ingredients to Avoid  Artificial flavorings  Asian cuisine flavoring  Bouillon cubes (beef, chicken, vegetable, etc)  Chicken broth  Edamame  Emulsifier  Glycine max  Hydrolyzed plant protein  Hydrolyzed protein  Hydrolyzed soy protein  Hydrolyzed vegetable protein (HVP)  Lecithin  Miso  Mono- and diglyceride  Monosodium glutamate (MSG)  Natto  Natural flavoring  Plant protein  Protein extender  Protein filler  Shoyu  Sobee® and other soy formulas  Soy albumin  Soy fiber  Soy flour  Soy grits  Soy meal  Soymilk  Soy nut butter  Soy nuts  Soy protein isolate  Soy sauce  Soy sprouts  Soya  Soybeans  Soybean butter  Soybean granules or curds  Tamari  Tempeh  Texturized vegetable protein (TVP)  Tofu  Vegetable broth  Vegetable gum  Vegetable starch  Worcestershire sauce 35

36. Soy Allergy 36  Soybeans have become a major part of processed food products such as baked goods, canned items, cereals, crackers, sauces, and soups  Avoiding products made with soybeans can be difficult. Check for soy as an ingredient in anything labeled as vegetarian or vegan as soy products are often added to boost nutrient value  Read labels carefully