All food businesses must inform you under food law
if they use any of the 14 regulated allergens as ingredients in the food and
drink, they provide.
Food law
identifies the following 14 allergens as the most potent and prevalent:
1.
Eggs
2.
Fish
3.
Peanuts
4.
Soybeans
5.
Milk
6.
Celery
7.
Mustard
8.
Sesame seeds
9.
Lupin
10. Molluscs (Such
as Mussels and Oysters)
11. Crustaceans,
e.g., crabs, prawns, lobsters
12. Cereals
containing gluten - wheat (such as spelt and khorasan wheat), rye, barley,
oats.
13. Nuts
(almonds, hazelnuts, walnuts, cashews, pecan nuts, brazil nuts, pistachio nuts,
macadamia/Queensland nut).
14. Sulphur
dioxide and sulphites (at concentrations of more than 10 mg/kg or 10 mg/L in
terms of total sulphur dioxide)
Food Labels
and Allergens
People with
food allergies should read labels and avoid the foods they are allergic to. The
law requires that food labels identify the food source of all major food
allergens used to make the food. This requirement is met if the common or usual
name of an ingredient already identifies that allergen's food source name (for
example, buttermilk). The law also requires that the type of tree nut (for
example, almonds, pecans, walnuts), and the species of fish (for example, bass,
flounder, cod) and Crustacean shellfish (for example, crab, lobster, shrimp) to
be declared. The allergen's food source must be declared at least once on
the food label in one of two ways.
The name of the
food source of a major food allergen must appear:
In parentheses
following the name of the ingredient.
Examples: “lecithin (soy),” “flour (wheat),” and “whey (milk)”
Or
Immediately
after or next to the list of ingredients in a “contains” statement.
Example: “Contains wheat, milk, and soy.”
Labeling
requirements extend to retail and food-service establishments that package,
label, and offer products for human consumption. However, FALCPA's labeling
requirements do not apply to foods that are placed in a wrapper or container
(such as paper or a box for a sandwich) following a customer’s order at the
point of purchase.
Consumers may
also see advisory statements such as “may contain [allergen] or “produced in a
facility that also uses [allergen].” Such statements are not required by law
and can be used to address unavoidable “cross-contact,” only if manufacturers
have incorporated good manufacturing processes in their facility and have taken
every precaution to avoid cross-contact that can occur when multiple foods with
different allergen profiles are produced in the same facility using shared
equipment or on the same production line, as the result of ineffective
cleaning, or from the generation of dust or aerosols containing an allergen.
FDA guidance
and regulations for the food industry states that advisory statements should
not be used as a substitute for adhering to current good manufacturing
practices and must be truthful and not misleading.
Allergenic
Substances
More than 160
foods have been identified to cause food allergies in sensitive individuals.
There are also several food ingredients that cause nonallergic hypersensitivity
reactions in sensitive individuals that require specific labeling. For example,
in addition to the major food allergens identified by law, the FDA monitors the
food supply to determine if other allergens, food ingredients, or food
additives pose a significant health risk and acts accordingly. Gluten, certain
additives (for example, yellow 5, carmine, sulfites), and other food allergens
for which new science has emerged, are examples of other substances the FDA
monitors and, in some cases, requires specific labeling for.
Gluten
Gluten describes
a group of proteins found in certain grains (for example, wheat, barley, and
rye). In people with celiac disease, foods that contain gluten trigger an
immune response that attacks and damages the lining of the small intestine.
Such damage may not only limit the ability of celiac disease patients to absorb
nutrients, leading to problems such as iron deficiency anemia, osteoporosis,
and malnutrition, but it puts them at increased risk for potentially serious
health problems, including intestinal cancers and autoimmune diseases such as
diabetes.
Color and Food
Additives
Some
individuals may have hypersensitivity reactions to a color additive. For
example, FD&C Yellow No. 5, widely found in beverages, desserts, processed
vegetables, drugs, makeup, and other products, may cause symptoms such as
itching and hives in some people.
Symptoms of
Food Allergies
Most
food-related symptoms occur within two hours of ingestion; often they start
within minutes. In some very rare cases, the reaction may be delayed by four to
six hours or even longer. Delayed reactions are most typically seen in children
who develop eczema as a symptom of food allergy and in people with a
rare allergy to red meat caused by the bite of a lone star tick.
Another type of
delayed food allergy reaction stems from food protein-induced
enterocolitis syndrome (FPIES), a severe gastrointestinal reaction that
generally occurs two to six hours after consuming milk, soy, certain grains and
some other solid foods. It mostly occurs in young infants who are being exposed
to these foods for the first time or who are being weaned. FPIES often involves
repetitive vomiting and can lead to dehydration. In some instances, babies will
develop bloody diarrhea. Because the symptoms resemble those of a viral illness
or bacterial infection, diagnosis of FPIES may be delayed. FPIES is a medical
emergency that should be treated with IV rehydration.
Not everyone
who experiences symptoms after eating certain foods has a food allergy or needs
to avoid that food entirely; for instance, some people experience an itchy
mouth and throat after eating a raw or uncooked fruit or vegetable. This may
indicate oral allergy syndrome – a reaction to pollen, not to the food itself.
The immune system recognizes the pollen and similar proteins in the food and
directs an allergic response to it. The allergen is destroyed by heating the
food, which can then be consumed with no problem.
Symptoms of
allergic reactions can include:
1.
Hives
2.
Flushed skin or rash
3.
Tingling or itchy sensation in the mouth
4.
Face, tongue, or lip swelling
5.
Vomiting and/or diarrhea
6.
Abdominal cramps
7.
Coughing or wheezing
8.
Dizziness and/or lightheadedness
9.
Swelling of the throat and vocal cords
10. Difficulty
breathing
11. Loss
of consciousness
People with a
known food allergy who begin experiencing any of these symptoms should stop
eating the food immediately, evaluate the need to use emergency medication
(such as epinephrine) and seek medical attention. Some of these symptoms are
not always due to a food allergen. So, it is important to seek proper care and
diagnosis from a healthcare provider to determine if the symptoms or reaction
experienced was due to a food allergen.
Menu and
Vending Machine Labeling
There are two
rules requiring that calorie information be listed on menus and menu boards in
chain restaurants and similar retail food establishments and vending machines.
Americans eat
and drink about one-third of their calories away from home. Making calorie
information available will help consumers make informed choices for themselves
and their families.
Menu
Labeling
Applies to
restaurants and similar retail food establishments if they are part of a chain
of 20 or more locations, doing business under the same name, offering for sale
substantially the same menu items and offering for sale restaurant-type foods.
Vending
Machine Labeling
Requires
operators who own or operate 20 or more vending machines to disclose calorie
information for food sold from vending machines, subject to certain exemptions.
How to Get
Tested
A food allergy
will usually cause some sort of reaction every time the trigger
food is eaten. Symptoms can vary from person to person, and you may not
always experience the same symptoms during every reaction. Allergic reactions
to food can affect the skin, respiratory tract, gastrointestinal tract and
cardiovascular system. It is impossible to predict how severe the next reaction
might be, and all patients with food allergies should be carefully counseled
about the risk of anaphylaxis, a potentially fatal reaction that is
treated with epinephrine (adrenaline).
While food
allergies may develop at any age, most appear in early childhood. If you
suspect a food allergy, see an allergist, who will take your family and medical
history, decide which tests to perform (if any) and use this information to
determine if a food allergy exists.
To make a
diagnosis, allergists ask detailed questions about your medical history and
your symptoms. Be prepared to answer questions about:
What and how
much you ate
How long it
took for symptoms to develop
What symptoms
you experienced and how long they lasted.
After taking
your history, your allergist may order skin tests and/or blood tests, which
indicate whether food-specific immunoglobulin E (IgE) antibodies are present in
your body:
Skin-prick
tests
Provide results
in about 20 minutes. A liquid containing a tiny amount of the food allergen is
placed on the skin of your arm or back. Your skin is pricked with a small,
sterile probe, allowing the liquid to seep under the skin. The test, which
isn’t painful but can be uncomfortable, is considered positive if a wheal
(resembling the bump from a mosquito bite) develops at the site where the
suspected allergen was placed. As a control, you’ll also get a skin prick with
a liquid that doesn’t contain the allergen; this should not provoke a reaction,
allowing comparison between the two test sites.
Blood tests
which are a bit
less exact than skin tests, measure the amount of IgE antibody to the
specific food(s) being tested. Results are typically available in about a week
and are reported as a numerical value.
Your allergist will
use the results of these tests in making a diagnosis. A positive result does
not necessarily indicate that there is an allergy, though a negative result is
useful in ruling one out.
In some cases,
an allergist will recommend an oral food challenge, which is considered the
most accurate way to make a food allergy diagnosis. During an oral food
challenge, which is conducted under strict medical supervision, the patient is
fed tiny amounts of the suspected trigger food in increasing doses over a
period of time, followed by a few hours of observation to see if a reaction
occurs. This test is helpful when the patient history is unclear or if the skin
or blood tests are inconclusive. It also can be used to determine if an allergy
has been outgrown.
Because of the
possibility of a severe reaction, an oral food challenge should be conducted
only by experienced allergists in a doctor’s office or at a food challenge
center, with emergency medication and equipment on hand.
Management
and Treatment
The primary way
to manage a food allergy is to avoid consuming the food that causes you
problems. Carefully check ingredient labels of food products, and learn whether
what you need to avoid is known by other names.
The Food
Allergy Labeling and Consumer Protection Act of 2004 (FALCPA) mandates that
manufacturers of packaged foods produced in the United States identify, in
simple, clear language, the presence of any of the eight most common food
allergens – milk, egg, wheat, soy, peanut, tree nut, fish and crustacean
shellfish – in their products. The presence of the allergen must be stated even
if it is only an incidental ingredient, as in an additive or flavoring.
Some goods also
may be labeled with precautionary statements, such as “may contain,” “might
contain,” “made on shared equipment,” “made in a shared facility” or some other
indication of potential allergen contamination. There are no laws or
regulations requiring those advisory warnings and no standards that define what
they mean. If you have questions about what foods are safe for you to eat, talk
with your allergist.
Be advised that
the FALCPA labeling requirements do not apply to items regulated by the U.S.
Department of Agriculture (meat, poultry and certain egg products) and those
regulated by the
Bureaucratic
The law also
does not apply to cosmetics, shampoos and other health and beauty aids, some of
which may contain tree nut extracts or wheat proteins.
Avoiding an
allergen is easier said than done. While labeling has helped make this process
a bit easier, some foods are so common that avoiding them is daunting. A
dietitian or a nutritionist may be able to help. These food experts will offer
tips for avoiding the foods that trigger your allergies and will ensure that
even if you exclude certain foods from your diet, you still will be getting all
the nutrients you need. Special cookbooks and support groups, either in person
or online, for patients with specific allergies can also provide useful
information.
Many people
with food allergies wonder whether their condition is permanent. There is no
definitive answer. Allergies to milk, eggs, wheat and soy may disappear over
time, while allergies to peanuts, tree nuts, fish and shellfish tend to be
lifelong.
Eating out
Be extra
careful when eating in restaurants. Waiters (and sometimes the kitchen staff)
may not always know the ingredients of every dish on the menu. Depending on
your sensitivity, even just walking into a kitchen or a restaurant can cause an
allergic reaction.
Consider using
a “chef card” – available through many websites – that identifies your allergy
and what you cannot eat. Always tell your servers about your allergies and ask
to speak to the chef, if possible. Stress the need for preparation surfaces,
pans, pots and utensils that haven’t been contaminated by your allergen, and
clarify with the restaurant staff what dishes on the menu are safe for you.
Anaphylaxis
Symptoms caused
by a food allergy can range from mild to life-threatening; the severity of each
reaction is unpredictable. People who have previously experienced only mild
symptoms may suddenly experience a life-threatening reaction
called anaphylaxis, which can, among other things, impair breathing and
cause a sudden drop in blood pressure. This is why allergists do not like to
classify someone as “mildly” or “severely” food allergic – there is just no way
to tell what may happen with the next reaction. In the U.S., food allergy is
the leading cause of anaphylaxis outside the hospital setting.
Epinephrine
(adrenaline) is the first-line treatment for anaphylaxis, which results when
exposure to an allergen triggers a flood of chemicals that can send your body
into shock. Anaphylaxis can occur within seconds or minutes of exposure to the
allergen, can worsen quickly and can be fatal.
Food
Allergies in Children
No parent wants
to see their child suffer. Since fatal and near-fatal food allergy reactions
can occur at school or other places outside the home, parents of a child with
food allergies need to make sure that their child’s school has a written
emergency action plan. The plan should provide instructions on preventing,
recognizing and managing food allergies and should be available in the school
and during activities such as sporting events and field trips. If your child
has been prescribed an auto-injector, be sure that you and those
responsible for supervising your child understand how to use it.
In November
2013, President Barack Obama signed into law the School Access to Emergency
Epinephrine Act (PL 113-48), which encourages states to adopt laws requiring
schools to have epinephrine auto-injectors on hand. As of late 2014, dozens of
states had passed laws that either require schools to have a supply of
epinephrine auto-injectors for general use or allow school districts the option
of providing a supply of epinephrine. Many of these laws are new, and it is
uncertain how well they are being implemented. As a result, ACAAI still
recommends that providers caring for food-allergic children in states with such
laws maintain at least two units of epinephrine per allergic child attending
the school.
Leftovers
and Food Safety
Often when we
cook at home or eat in a restaurant, we have leftovers. To ensure that
leftovers are safe to eat, make sure the food is cooked to a safe temperature
and refrigerate the leftovers promptly. Not cooking food to a safe temperature
and leaving food out at an unsafe temperature are the two main causes of
foodborne illness. Safe handling of leftovers is very important to reducing
foodborne illness.
·
Cook Food Safely at Home
·
Keep Food out of the Danger Zone
·
Cool Food Rapidly
·
Wrap Leftovers Well
·
Store Leftovers Safely
·
Thaw Frozen Leftovers Safely
·
Reheating Leftovers without Thawing
·
Reheat Leftovers Safely
·
Refreezing Previously Frozen Leftovers
Cook
Food Safely at Home
The first step
in having safe leftovers is cooking the food safely. Use a food thermometer to
make sure that the food is cooked to a safe, minimum internal temperature.
Red
meats: Cook all raw beef, pork, lamb and veal steaks, chops, and roasts to
a minimum internal temperature of 145° F as measured with a food thermometer
before removing meat from the heat source. For safety and quality, allow meat
to rest for at least three minutes before carving or consuming. For reasons of
personal preference, consumers may choose to cook meat to higher temperatures.
Ground
meats: Cook all raw ground beef, pork, lamb, and veal to an internal
temperature of 160° F as measured with a food thermometer.
Poultry: Cook
all poultry to an internal temperature of 165° F as measured with a food
thermometer.
Keep Food out of the Danger Zone
Bacteria grow
rapidly between the temperatures of 40° F and 140° F. After food is safely
cooked, hot food must be kept hot at 140° F or warmer to prevent bacterial
growth. Within 2 hours of cooking food or after it is removed from an appliance
keeping it warm, leftovers must be refrigerated. Throw away all perishable
foods that have been left in room temperature for more than 2 hours (1 hour if
the temperature is over 90° F, such as at an outdoor picnic during summer).
Cold perishable food, such as chicken salad or a platter of deli meats, should
be kept at 40° F or below. When serving food at a buffet, keep food hot in
chafing dishes, slow cookers, or warming trays. Keep food cold by nesting
dishes in bowls of ice or use small serving trays and replace them often.
Discard any cold leftovers that have been left out for more than 2 hours at
room temperature (1 hour when the temperature is above 90 °F).
Cool
Food Rapidly
To prevent
bacterial growth, it's important to cool food rapidly so it reaches as fast as
possible the safe refrigerator-storage temperature of 40° F or below. To do
this, divide large amounts of food into shallow containers. A big pot of soup,
for example, will take a long time to cool, inviting bacteria to multiply and
increasing the danger of foodborne illness. Instead, divide the pot of soup
into smaller containers so it will cool quickly.
Cut large items of food into smaller portions to cool. For whole roasts or
hams, slice or cut them into smaller parts. Cut turkey into smaller pieces and
refrigerate. Slice breast meat; legs and wings may be left whole.
Hot food can be placed directly in the refrigerator or be rapidly chilled in an
ice or cold water bath before refrigerating.
Wrap Leftovers Well
Cover
leftovers, wrap them in airtight packaging, or seal them in storage containers.
These practices help keep bacteria out, retain moisture, and prevent leftovers
from picking up odors from other food in the refrigerator. Immediately
refrigerate or freeze the wrapped leftovers for rapid cooling.
Store Leftovers Safely
Leftovers can
be kept in the refrigerator for 3 to 4 days or frozen for 3 to 4 months.
Although safe indefinitely, frozen leftovers can lose moisture and flavor when
stored for longer times in the freezer.
Thaw Frozen Leftovers Safely
Safe ways to
thaw leftovers include the refrigerator, cold water and the microwave oven.
Refrigerator thawing takes the longest but the leftovers stay safe the entire
time. After thawing, the food should be used within 3 to 4 days or can be
refrozen.
Cold water thawing is faster than refrigerator thawing but requires more
attention. The frozen leftovers must be in a leak-proof package or plastic bag.
If the bag leaks, water can get into the food and bacteria from the air or
surrounding environment could enter it. Foods thawed by the cold-water method
should be cooked before refreezing.
Microwave thawing is the fastest method. When thawing leftovers in a microwave,
continue to heat it until it reaches 165° F as measured with a food
thermometer. Foods thawed in the microwave can be refrozen after heating it to
this safe temperature.
Reheating Leftovers without Thawing
It is safe to
reheat frozen leftovers without thawing, either in a saucepan or microwave (in
the case of a soup or stew) or in the oven or microwave (for example,
casseroles and combination meals). Reheating will take longer than if the food
is thawed first, but it is safe to do when time is short.
Reheat Leftovers Safely
When reheating
leftovers, be sure they reach 165° F as measured with a food thermometer.
Reheat sauces, soups and gravies by bringing them to a rolling boil. Cover
leftovers to reheat. This retains moisture and ensures that food will heat all
the way through.
When reheating in the microwave, cover and rotate the food for even heating.
Arrange food items evenly in a covered microwave safe glass or ceramic dish,
and add some liquid if needed. Be sure the covering is microwave safe, and vent
the lid or wrap to let the steam escape. The moist heat that is created will
help destroy harmful bacteria and will ensure uniform cooking. Also, because
microwaves have cold spots, check the temperature of the food in several places
with a food thermometer and allow a resting time before checking the internal
temperature of the food with a food thermometer. Cooking continues for a longer
time in dense foods such as a whole turkey or beef roast than in less dense
foods like breads, small vegetables and fruits.
Refreezing Previously Frozen Leftovers
Sometimes there
are leftover "leftovers." It is safe to refreeze any food remaining
after reheating previously frozen leftovers to the safe temperature of 165° F
as measured with a food thermometer.
If a large container of leftovers was frozen and only a portion of it is
needed, it is safe to thaw the leftovers in the refrigerator, remove the needed
portion and refreeze the remainder of the thawed leftovers without reheating
it.
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