Food Allergies/ Intolerances and Vegan Cross-Contact Prevention

In-Service Training

Objectives:

1. Understand the difference between food allergies and intolerances, their risks and symptoms.
2. Identify top 8 food allergies and allergy-free foods that can be offered to patients with those.
3. Describe proper food handling procedures for someone with a food allergy or intolerance.
4. Describe vegetarian and vegan diets.
5. Identify hidden non-vegan ingredients in common foods.

Introduction:
Food allergies are a growing food safety and public health concern that affect an estimated 8% of
children in the United States. That's 1 in 13 children, or about 2 students per classroom.
Food allergies are the leading cause of anaphylaxis, a sudden, severe and potentially life-threatening
allergic reaction.1

What is a food allergy?

 A food allergy is a specific type of food reaction involving the immune system. The body
produces what is called immunoglobulin E (IgE), an antibody to a food. Once a specific food is
ingested and binds with the IgE antibody, an allergic reaction occurs.
 Although there is no cure for food allergies, some can be outgrown, and studies have shown the
severity can change throughout a person’s life. The best preventative action is strict avoidance
of the allergen(s).
 Symptoms can appear from within minutes or up to 2 hrs after a person has eaten the food,
they are allergic to, and can range from mild to life-threatening.
 Those who have previously experienced only mild symptoms may experience a life-threatening
reaction called anaphylaxis, which can impair breathing/cause sudden drop in blood pressure.
 Allergic reactions can also include: hives, flushed skin or rash, tingling or itchy sensation in the
mouth, face, tongue, or lip swelling, vomiting and/or diarrhea, coughing or wheezing, dizziness,
swelling of the throat, difficulty breathing, fainting, loss of consciousness
 The prompt administration of epinephrine by an auto injector (EpiPen) during early symptoms
of anaphylaxis may help prevent serious consequences.2-3

What top 8 foods cause allergies?

• The Food Allergen Labeling and Consumer Protection Act (FALCPA) has identified the eight most
common allergenic foods which account for 90% of food allergic reactions. These eight, and any
ingredient that contains protein derived from them, are designated as “major food allergens” by the
FALCPA, passed by Congress in 2004 and became effective in 2006. 2

 Milk (casein and whey)

 Eggs
 Fish (such as bass, flounder, cod)
  Crustacean shellfish (crab, lobster, shrimp)
 Tree nuts (almonds, walnuts, pecans)
 Peanuts
 Wheat (gluten)
 Soy2

What allergy free foods can be offered to residents who have food allergies?

 Rice, quinoa, buckwheat and corn are all gluten free and good for those with gluten
allergy/Celiac or gluten intolerance.
 Soy milk can be used in place of dairy for lactose intolerance.
 Sunflower butter can be used in place of peanut butter for peanut allergies.
 All food products containing two or more ingredients are required by Federal regulations to bear
an ingredients statement with ingredients by common in descending order of predominance. 1-2

What is a food intolerance?

 A food intolerance is also known as a ‘non-allergic food sensitivity’.

 They do not trigger the immune system and there is no immune response related. 2
How do we prevent cross contact?
• Cross contact is when a food comes in contact with another food, and their proteins mix. Even this
trace of food protein has caused reactions in allergic people. Cross-contamination is also a concern for
vegans. This occurs when food is stored or prepared on the same surface where an animal containing
product was.

 Ex. peeling cheese off a cheeseburger to make it a hamburger or taking the shrimp off of
a salad and serving it.
 Ex. vegan burgers being cooked on the same grill as animal burgers. 2
What is Vegetarian and Vegan?

 Both vegetarians and vegans choose not to eat meat, poultry and fish. However, veganism is a
stricter form of vegetarianism that prohibits the consumption or use of any products that come
from animals, including dairy, eggs, honey, and all other animal-derived ingredients.4

What foods have hidden animal ingredients?

Some ingredients are trickier to spot, especially those used as additives or fillers in processed foods. These
are not as easy to detect as the obvious no-no’s like meat, eggs, and milk, but they are still derived from
animals. Therefore, they are generally avoided on a vegan diet.5

 Honey and Beeswax: Beeswax can be found in candies. Honey is a common sweetener
used in a variety of food and beverage products.
 Casein or Milk by-products: Casein is a protein derived from animal’s milk and is the main
component in cheese making. Sometimes casein will be listed as an ingredient in non-
dairy food items, such as soy cheese or coffee creamer. This ingredient is usually listed as
casein, calcium caseinate, or sodium caseinate.
 Whey Protein: Whey is a common ingredient in many foods, especially bread and candies,
and is a by-product of cheese making. Dairy and egg derivatives can be used to preserve
shelf life in processed sandwich bread.
 L. Cysteine: This is an enzyme used as a “dough conditioner” sourced from duck and
chicken feathers.
 Condiments and sauces: Worcestershire, ranch and barbeque sauce are the main
culprits here. Worcestershire and ranch usually contains anchovies, but there are vegan
versions available. Some barbeque sauces also contain Worcestershire, in addition to
other potential animal-derived ingredients like honey.
 Marshmallows & Jello: Both contain gelatin which is made from bones and some
marshmallows may also contain egg whites. Gelatin is also found in candies and fruit
snacks.5-6
 Food Allergies & Intolerances (w/cross-contact prevention)

Pre-Test

1. True or False: A food intolerance can cause anaphylaxis.

2. Which of the following is NOT one of the “TOP 8” food allergies?

a) Peanut

b) MSG/monosodium glutamate

c) Soy

d) Dairy

3. True or False: A food intolerance is also known as a ‘non-allergic food sensitivity’.

4. True or False: People with asthma are less at risk of fatal anaphylaxis.

5. Other than prep services/pots/pans, what can cause cross-contact to occur?

a) unclean thermometers

b) unclean hands

c) dirty aprons

d) all of the above

6. True or False: Quinoa and buckwheat are gluten free grains.

7. Which of the following is NOT allowed on a vegetarian diet?

a) honey

b) dairy

c) eggs

d) none of the above

8. True or False: A ‘rice crispy treat’ is a great dessert for someone following a vegan diet.
 Food Allergies & Intolerances (w/cross-contact prevention)

Post-Test

1. True or False: A food intolerance can cause anaphylaxis.

2. Which of the following is NOT one of the “TOP 8” food allergies?

a) Peanut

b) MSG/monosodium glutamate

c) Soy

d) Dairy

3. True or False: A food intolerance is also known as a ‘non-allergic food sensitivity’.

4. True or False: People with asthma are less at risk of fatal anaphylaxis.

5. Other than prep services/pots/pans, what can cause cross-contact to occur?

a) unclean thermometers

b) unclean hands

c) dirty aprons

d) all of the above

6. True or False: Quinoa and buckwheat are gluten free grains.

7. Which of the following is NOT allowed on a vegetarian diet?

a) honey

b) dairy

c) eggs

d) none of the above

8. True or False: A ‘rice crispy treat’ is a great dessert for someone following a vegan diet.
 Answer key

1. False. A food intolerance can cause severe pain and discomfort, but a food allergy causes an immune
response resulting in anaphylaxis.

2. b) MSG/monosodium glutamate. Some people are sensitive to MSG (often in Asian foods) and may
have headaches, mood changes or asthma, though it is not one of the top 8 food allergens.

3. True. An intolerance sometimes people refer to as a sensitivity.

4. False. They are more at risk. The main reason people die of anaphylaxis is their airways shut down. If
underlying asthma, airways are likely to be more sensitive to an allergic reaction.

5. d) All of the above. Dirty hands, aprons, thermometers, and utensils could cause cross-contact of
allergens! It’s important to keep this in mind as we serve guests and families visiting the residents
(grandchildren who may be joining grandma or grandpa for a meal).

6. True. Both can be used in dishes served to people with gluten allergy/Celiac disease or intolerance.

7. d) none of the above. All of these foods are consumed on a vegetarian diet.

8) False. ‘Rice Crispy Treats’ contain marshmallow which is made with gelatin, a beef product.
 References

1. https://www.cdc.gov/healthyschools/foodallergies/index.htm#:~:text=Food%20allergies%20are
%20a%20growing,children%20in%20the%20United%20States.&text=That's%201%20in%2013%2
0children,immune%20response%20to%20certain%20foods. Accessed October 5, 2020.
2. Food Intolerances vs Food Allergies
http://www.todaysdietitian.com/newarchives/100111p52.shtml. Accessed October 5, 2020.
3. Outgrowing Food Allergies: Multiple Factors Affect Outcome
http://www.todaysdietitian.com/newarchives/050113p12.shtml. Accessed October 5, 2020.

4. https://www.cedars-sinai.org/blog/is-vegetarian-or-vegan-diet-healthy.html. Accessed October 5,

2020.

5. https://www.thespruceeats.com/sneaky-non-vegan-ingredients-3371739. Accessed October 5,

2020.