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Food allergies and intolerances - Module 2

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1 Food allergies and intolerances - Module 2
Identifying / locating allergens

2 Module 2 - Learning Outcomes
This section will look at the common 14 plus allergens by identifying each, where they are found, and with examples of prepared foods hiding the allergens. 1. You will learn the source of each allergen, where it may be hidden in processed foods and the likely symptoms. 2. You will have an understanding of allergens and where they are to be found so that you can maintain effective communication with your customer. 3. You will have the underpinning knowledge to prepare a hazard analysis. Hazard analysis and HACCP we will meet in the next and final section

3 Module 2. Identifying Allergens Where are allergens commonly found?
In this section you will learn about each of the common allergens, and where they are found. It is important that you are aware which foods contain allergens so that you are able to prepare all dishes with a full knowledge of their allergen content. (In Section 3 we will focus on the practical measures that you can apply during your daily working routine to ensure that the risk of allergen contamination is eliminated.)

4 Keeping Records This will form part of your HACCP system as all allergens and intolerances must be considered as a hazard. New legislation from December 2014 requires every food outlet to be able to inform their customers which dishes contain which allergens. To be able to do this you need to know where allergens are to be found, in which products allergens are used as ingredients, these we call hidden allergens. Knowing where the allergens are in your kitchen is an important part of your HACCP system.

5 14 Allergens European Legislation has identified the 14 common allergens – But, there are more than 200 foods that are known to have caused an allergic reaction. It is impossible to predict exactly which foods a customer may react to, showing just how important it is to listen to your customer. The list of 14 does not give a complete picture so be aware that other foods can cause reactions too. A few more than the 14 items have been included in this course

6 Peanuts Probably the fastest growing allergy that often affects children from infancy. Most people with a peanut allergy will also be allergic to other nuts, so all must be eliminated from the customer's meal. Peanuts are a common snack and the crumbs are very easily found at home in clothes and furniture. These small amounts can cause a reaction.

7 Peanuts cont. Peanuts are one of the most dangerous allergens because only a tiny amount is required to cause an anaphylactic reaction, which can be fatal. Food handlers should not eat peanuts at work. It is obvious to see why no food handler should ever eat peanuts at work, you may never know that a customer has an allergy; they may have come in for a cup of coffee or just a glass of water. If the waiter serving this customer has been eating peanuts and does not wash his hands thoroughly a potentially lethal situation can be created. Airborne On skin and clothes Air conditioning

8 More about peanuts Heating does not make not an allergen safe but in Europe peanut oil is safe because during the refining process the allergen has been removed. Walnut oil must be avoided as this contain a lot of nut allergy proteins which can cause a reaction to a person suffering from a peanut allergy. Peanuts are not actually nuts but are a vegetable, a legume the same group as peas and beans. However, most people who have a peanut allergy are also allergic to nuts. So when a person tells you that they are allergic to peanuts you need to ensure that no nuts are in their food. Anyone with either a nut or peanut allergy need to have both eliminated from their food. It it is common to find that when a person has an allergy to one allergen, they will have an allergy to similar products such as peanuts and nuts. This reactivity to more than one allergen is called cross-reactivity. If you work in a restaurant, using peanuts in many dishes such as a Thai restaurant, it will be impossible to ensure safety for a person suffering from a peanut allergy. Therefore there should be a clear warning on the menu such as: We use peanuts in many of our dishes and if you are allergic to peanuts we kindly advise you to choose another restaurant as we cannot promise that any of dishes are peanut free.

9 Only tiny amounts can cause reaction
The smallest amount of a peanut can cause a dangerous reaction. It is so tiny that it is airborne - that means that any allergy sufferer being near peanuts is at risk. It can be very dangerous to have open peanut displays or to place peanuts on the table or bar. Contamination from food or drinks staff serving an allergic customer. Peanuts are one of the most dangerous allergens not only because only the smallest amount is required but also that it can cause an anaphylactic reaction.

10 Where may peanuts be found?
As even the smallest amount of peanut is dangerous - which foods contain peanuts? Peanuts are found in a wide range of snacks and confectionary Marzipan is made from almonds yet the almond paste may contain peanuts. This is because peanuts are less expensive than almonds Peanuts are found in nougat Peanuts are found in flour as used in Indian dishes Peanuts are in a number of sauces Satay and pesto use peanuts

11 Nuts - Tree Nuts Nuts allergies are closely related to peanut allergies and also sesame seeds. All 3 can cause anaphylactic shocks. This reactivity to more than one allergen is an example of cross-reactivity. Nut allergies are also increasing. It is wise to treat anyone with a nut allergy, a peanut allergy and a sesame seed allergy as one and the same so eliminate all of them entirely from their meals. This may sound complicated, yet understanding cross-reactivity combines several allergens into a single group, which can be easier to manage. (More detail in Section 3)

12 This group includes all nuts:
Walnuts Brazil nuts Macadamia Cashew Chestnuts Hazel nuts Pecan Pine nuts, also known as pignolia Pistachios

13 Foods commonly containing nuts
Pesto - Italian paste made with pine nuts Marzipan - almond paste, which sometimes may contain peanuts Nutella - a chocolate and nut spread Baklava - a well know Greek/Turkish dessert made with a variety of chopped nuts Nougat - a range of nuts including almonds, hazelnuts, pistachios and walnuts Turron - a Spanish version of nougat with many different nuts Gianduja - chocolate paste with hazel nuts Biscuits /cookies Fruit cakes A wide selection of confectionary and ice creams Chocolates

14 Care with nuts Nuts are commonly added to many dishes, especially confectionary and desserts. All processed foods such as biscuits must be carefully checked and recorded. As part of hazard analysis you will need to check every item to build a list of all products containing allergens to allow you up to date information for your customer. Recipe development and planning will be discussed later, but it is important to consider garnishes. It is best to avoid garnishing with any allergen item. If an allergen is used, the dish must be clearly labelled so that all of your colleagues know that the dish contains allergens Careless garnishing has killed!

15 Sesame seeds Sesame seeds allergy is similar to that of peanuts and tree nuts, so the customer needs to have all 3 eliminated from their food. Sesame seeds can produce an anaphylactic reaction. They are used extensively in Middle Eastern cuisine and therefore unsurprisingly the greatest increase in sesame seed allergies is in people from this region. Sesame has long been a staple part of the cuisine for more than 3,500 years as recalled by historian, Herodotus. Sesame seeds as used for oil needs to be avoided as not all refining processes remove the must be eliminated from the customer's meal.

16 Foods containing sesame seeds:
Tahini - a paste made from ground sesame seed Hummus - a blend of olive and tahini, sesame seed paste Baba Ghanoush - frequently seasoned with sesame seed oil or its paste, tahini. Bread and Buns - sesame seeds added for flavour and texture fast food chains use sesame seeds on their hamburger buns. Crackers Japanese salads and many Japanese prepared dishes including gomashio made from roasted sesame seeds. Indian cuisine uses sesame seeds including black seeds for sesame seed balls

17 Use of sesame seeds Biscuits and cookies Sesame bars Bread sticks
widely used in a variety of cuisines ranging through the Middle East, the Maghreb, North Africa, Greece, Turkey, Pakistan, and India and in oriental cuisine both Japanese and Chinese. It can be found in salad dressing and Japanese dips for sushi and sashimi.

18 Mustard and Mustard seeds
Mustard - a well known condiment but it also finds its way many recipes such as mayonnaise and sauces, both purchased ready made and prepared on the premises. This emphasises the importance of record keeping and label checking. In the most severe reaction an anaphylactic shock can occur, though fortunately mustard allergies are fairly rare.

19 Foods that may include mustard:
Barbecue sauces Tomato ketchup Marinades Mayonnaise Meat that has been processed such sausages Seasoned flour used for batter such as for frying fish Pickles - piccalilli Salad dressings - vinaigrette Many spices and seasoning mixes Gravy mixes Curry sauces All pre-prepared dishes and ready meals

20 More uses for mustard This allergen though less common as an allergy is found is many foods both purchased and prepared. Mustard is used for many seasoning applications and is required to be on all labelled food. For your recipes always keep a record of all the ingredients. Mustard oil - this is used for frying especially in North Indian curries so it is not only the seeds that are used for food Mustard leaves are used in salads. Mustard sprouts are used again in salads. You need to check the mixture of leaves in your pre-packaged salads. Cross reactivity there are growing signs that those with a mustard allergy will also react to colza oil, also known as rape seed oil. Mustard oil is widely used in many processed foods.

21 Lupin seeds from the lupin plant
Lupin seeds are ground into flour for pastries. It is not commonly used in UK but it is fairly common in France. This makes checking all prepared foods especially pastries from France essential and also adjusting your supplier specifications. Fortunately, for this type of flour there are common substitutes and therefore it is fairly easy not to purchase any product-containing lupin.

22 Typical products that may contain lupin include:
Pastries especially pastry cases and shells Waffles Pies Pancakes Pizza Batter and flour mixes used for deep-frying Cross reactivity all those with peanut allergies have been advised to eliminate lupin from their diet

23 Soya Soya belongs to the vegetable family legumes, which include peanuts and lupin. However, it is less cross reactive with peanuts than other allergens. Soya is very common in all diets and is found in many processed foods. It is used as flour as well as an oil, and as a direct ingredient such as soy sauce; therefore there are many products in which it can be found. As with all these allergens the importance of thoroughly reading and keeping labels of all processed foods cannot be underestimated.

24 Typical soya products include:
All baked products including bread: Vegetable protein - often called either hydrolysed vegetable protein HVP or textured vegetable protein TVP. Lecithin E322 - this is an emulsifier, an emulsifier makes the combination of liquids smooth and consistent such as mayonnaise, therefore you will find emulsifiers in many sauces and salad dressings, spreads and margarines. Lecithin is normally made from unrefined soya oil. Soya oil, refined soya is considered to be safe as the allergen has been removed during refining, however unrefined soya oil should be avoided in all circumstances. Soy sauce - a common condiment found in Japanese and Far Eastern cuisine. Tofu - also known as soya bean curd and frequently used as a meat substitute and in vegetarian dishes.

25 Gluten - the protein in flour
Gluten made of 2 proteins is in many flours giving bread dough its elasticity; so is an important part of baking and is found in pasta as it is also made from wheat flour, durum wheat. Allergies affect different people in different ways, ranging from the less severe gluten sensitivity to more serious coeliac disease.

26 Gluten can be found in the following foods:
All bread and baked products Cereals Pasta Pastries Biscuits Desserts Couscous Semolina Tabouleh

27 It may be more difficult to identify when flour is used in sauces and mixtures:
Gravies Many sauces Soups Processed vegetable dishes All battered items such as fish for frying Condiments Beer Vegetable starch The list is very long, but fortunately there are substitutes that can provide a gluten free alternative.

28 Gluten free substitutes
There are a variety of alternative flours that can be safely used these include: Potato flour Rice flour Maize or corn (cornflour) Soya flour Buckwheat Chickpeas beans and lentils Arrowroot It is reasonably simple to change your recipe for a sauce by using arrowroot or corn flour as alternative thickening agents.

29 Celery and Celeriac This allergy is more commonly found in central Europe and Switzerland and shows a cross reactivity with a number of pollens. Generally it is the celeriac root, which causes the most severe reactions, and cooking will not reduce its effect.

30 Celery can be found in: Celery sticks and mixed salads Celeriac root
Stocks, stews and soups Celery as a seasoning - all products containing celery will be labelled, and must be eliminated from the customer's meal. Once again the importance of accurate and complete record keeping is paramount.

31 Fish, Molluscs and Crustaceans
This group of 3 can be seen together but also separately. Some people are perfectly able to eat fish such as cod but not shrimp, so there is a difference between fish, shellfish called crustaceans and molluscs, bi- vales oyster and mussels. Generally, people who have a reaction to one type of fish, mollusc or crustacean can react to the others.

32 Fish molluscs and crustacean can be found in:
Processed fish products Worcestershire sauce & Gentleman's Relish contain anchovies Oyster sauce - used in Chinese and oriental dishes such as stir-fry Shrimp sauce - frequently used in Japanese and Chinese cooking Anchovy sauce - this may be used in gravies and sauces Taramasalata Remoulade sauce - again some recipes include anchovies Compound butters - shrimp butter and cafe de Paris butter again containing anchovies and Worcestershire sauce Fish sauces especially made with anchovies and small fish intestines have been popular since Greek and Roman Times. Generally such sauce factories were banned from cities due to their foul smell yet survived because the sauce garum was considered to possess medicinal qualities, and raw anchovies an aphrodisiac

33 Molluscs This group of shellfish includes 3 sub groups:
Bivalves - mussels, oysters, abalone, scallops and clams Cephalopods - octopus, squid (also know as calamari) cuttlefish Gastropods - snails (escargot) limpets, winkles In most cases it is clear that these foods are easy to identify and to keep separate, but some are used as interesting ingredients. Oyster sauce as mentioned before, is very common in Chinese cooking and can be found in many sauces especially those used in wok style preparation.

34 Crustaceans This group includes shrimps, prawns, crab, crayfish and lobster. All very popular foods and easy to identify but are hidden ingredients in many processed foods and sauces, such as shrimp sauce used in oriental cooking. Fish and shellfish make up a large group of allergens and find their way into many sauces and other complex or processed foods. Shrimps, prawns and other shellfish are often used as garnishes so the fact that they are allergens must be considered. Carefully, read the labels of all purchased sauces so that you know exactly what is contained in each. This is an essential part of your record keeping system.

35 Eggs Even the widely used egg can cause an allergic reaction. It is impossible to list all the foods that can contain eggs. This is the second most common allergy amongst children, the first being milk. As with many other allergens egg content is required to be listed on all products by European legislation. Eggs have two parts, the yolk and the white, some people may be allergic to one and not the other, or both; there is nothing simple about allergies. As always, ‘fail safe’, the recommendation is to eliminate all parts of the egg both white and yolk from the customer's meal.

36 Eggs as ingredients It is difficult to write a full list of all foods containing eggs but examples are: A wide variety of egg dishes or where eggs are the main ingredient Cakes Pastries Choux paste Sauces - hollandaise, mayonnaise plus many more Ice cream Sorbet - as a stabiliser Preservatives - even processed ham.

37 More about eggs Eggs are commonly used in the kitchen and sometimes there will be breaks and spills on work surfaces, which should always be immediately cleaned, (Food Safety and chance of an allergen contamination). The list of products containing eggs is long therefore you will need to identify all the products served in your kitchen containing eggs either the white or the yolks so all employees are aware which products eggs or egg derivatives such as powdered egg can be found. Powdered and dried eggs are added to many products, again it is essential to make a record of all the products and their ingredients.

38 Milk Milk is a food that causes intolerance, lactose intolerance and an allergy; milk allergy is the most common of all allergies amongst babies and children. (Already discussed in Unit I.)

39 Milk products include:
Milk as a drink or drink base (hot chocolate and milkshakes) Cheese Yoghurt Cream Ice cream Butter Fromage frais Creme fraiche Pastry creams and custards The hidden allergens may be found in a wide range of products including: Pastries Bread Biscuits and cookies Many sauces such as bechamel and its many derivatives such as mornay sauce Desserts Dry drinks mixes such as hot chocolate and Ovaltine Remember label reading and recording all ingredients in your house recipes, you will then have a complete list of all your foods containing milk allowing you to serve your customer safely.

40 Sulphites Sulphites are used as a preservative for many dried fruits, and to stop further fermentation of wine, it is sometimes used in the brewing of beer and can be found in many drinks. It only rarely causes an anaphylactic reaction but it is classed as major allergen as it affects many people, including those with asthma. This may be because it produces an acid and may cause breathing difficulties.

41 Sulphites are frequently found in the following foods:
Baked foods Soup mixes Jams and other preserves Canned vegetables Pickles and chutneys Shrimp - if treatment occurs at sea it may not be recorded Dried fruits such as apricots sultanas Cider Some soft drinks Wine and beer - except organic wine and beer Grape juice and several fruit juices Vinegar

42 Sulphites cont. Grape juice and several fruit juices Vinegar Tea
A wide range of products and substances use sulphites as preservatives and can have a variety of E numbers and different names.


44 Tomato Generally an allergic reaction is to raw tomatoes and therefore may seem easily enough to avoid, yet it is highly recommended that cooked tomatoes and tomato sauce is not given to the customer who reacts to tomato. As discussed earlier, tomato in a bolognaise sauce caused death. This raises the question how much must the tomato be cooked. This makes life complicated, and remembers it is always best to ‘Fail Safe’.

45 Kiwi A number of people are allergic to this fruit and interestingly there is cross-reactivity with latex and to other foods including, avocado, banana and carrots . This shows how cross reactivity can result in what appears to be very different items, but the similarity of the protein molecules cause the problem. Kiwi

46 Chickpeas In India where chickpeas are a staple food, chickpea allergy is increasingly significantly. A problem with identifying those allergic to chickpeas is that chickpeas go by a number of different names in different languages - garbanzo, ceci, chana, hummus and gram. Originally in the west it was named, cicer after the wart on Cicero's nose that resembled this bean. Again this pulse or bean is widely used in many cuisines and mixed into a variety dishes as well as being ground into flour,(gram).

47 Rice As with chickpeas in India, and peanuts in Britain and the USA it is the easily found ingredients that are the cause of allergies. It is not surprising then that rice allergies appear where it is consumed most. Also be aware of ground rice / rice flour in biscuits, cakes, puddings and as a thickener.

48 A wide range of allergens
Working in an international setting you might be surprised by what someone may be allergic to. That is why it is so important to listen to your customer and make sure that you have properly understood what they tell you. You are aware that many foods can cause allergic reactions, the safest way to look at this problem is to accept that water has never caused an allergic reaction. This means that any food can cause an allergic reaction, but for practical reasons of the hospitality business we focus on the 14 most common allergens, and always listen to our customer, very seriously no matter how strange their allergy may sound. In this section you have learnt about many different allergens and where they are found. You have understood that allergens are contained in processed foods and sauces, these are called "hidden allergens". Therefore you must build a list of all the allergens in your kitchen as part of your Hazard Analysis. You will see how this is done in the next section and how you will prepare food that free of a particular allergen or allergens.

49 Module 2 Key points and revision
EU Legislation lists 14 allergens – can you name them? What other allergens or intolerances have you come across? What are hidden allergens? Give some examples What is the difference between food allergy and food intolerance? What is Cross Reactivity? If someone is allergic to peanuts they may also be allergic to…………………… What is the purpose of sulphites in food and drinks. Which people are most likely to react to sulphites?

50 Module 2 Key points and revision
8. What is the allergen commonly found in flour called. What is the name of the illness related to this 9. Where may traces of fish or shellfish be found without it being obvious? 10. Which popular garnishes used on food could be allergens.

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