Catering Guide To Severe Food Allergies

Allergic reactions can occasionally be life-threatening and people who know they are at risk must always remain vigilant when food is around. Severe allergic reactions to foods are on the increase.

The ingredients most commonly associated with severe reactions are: Peanuts, Tree nuts (Almonds, Hazelnuts, Brazil & Walnuts), and Seeds (Sesame & Poppy). Exceptionally small amounts can trigger severe allergic reactions in sensitive people.

Many manufacturers, retailers & caterers have responded well to the problem by improving customer information. However, customers are still being 'caught out' by unexpected ingredients after receiving false assurances from staff that a particular product is safe. Prompt medical attention is vital and saves lives, but a few are not so lucky. In Britain, there are about 6 reported deaths each year due to food induced anaphylaxis. Most of these fatal reactions are triggered by food eaten out. The true number of deaths may in fact be higher.

Plainly, life threatening allergies, known as anaphylaxis, are of great concern to the catering industry. Guidance is obtainable from the Food Standards Agency Website or telephone 020 7276 8516

What is Anaphylaxis?

Anaphylaxis is a severe allergic reaction - the extreme end of the allergic spectrum. The whole body is affected, usually within minutes of exposure to the allergen but sometimes after hours. Causes include food, insect stings and drugs.

What are the symptoms?

Any or all of the following symptoms may be present:

• Itching or a strange metallic taste in the mouth
• Swelling of throat and tongue.
• Difficulty in swallowing or speaking.
• Difficulty in breathing - due to severe Asthma or throat swelling.
• Hives (nettlerash) anywhere on the body.
• Generalised flushing of the skin.
• Abdominal cramps, nausea and vomiting.
• Sudden feeling of weakness (drop in blood pressure).
• Sense of doom
• Collapse and unconsciousness.

What foods trigger life-threatening allergic reactions?

The most common culprits are peanuts and tree nuts (Walnuts, Almonds, Hazelnuts, Brazils).

However, other foods may be implicated on rare occasions. Any customer who claims to suffer life-threatening allergic reactions to a food should be taken seriously. Foods which sometimes cause severe reactions include eggs, dairy products, sesame seeds and other seeds, shellfish, fish, soya, pulses, and fresh fruit.

What quantities can trigger a severe reaction?

For some people, tiny traces of a particular food can cause anaphylaxis.

How common is anaphylaxis?

Statistics are hard to come by, but 1 in 300 children is believed to suffer allergic reactions to peanuts, tree nuts or both. A small but significant number are affected by other foods.

How do these people protect themselves?

Many carry medication, to be taken if they inadvertently eat the food that affects them. But first and foremost, they must seek to avoid the offending food. They need accurate information about ingredients of foods they are about to eat.

What can catering managers do?

Managers can devise a system whereby there is always at least one staff member on duty who has access to accurate ingredient information. Staff with any queries about any dish on the menu can go to that person for help.

Customers with allergies can be encouraged to question staff. Signs can be displayed stating: "Severe food allergies. We welcome enquiries from customers who wish to know whether any meals contain particular ingredients."

Managers can minimize risks by seeking to avoid situations where cross-contamination can occur. The next page contains practical advice for managers and staff.

What Caterers can do

Guidance for Managers and Senior Staff.

• Ensure there is always a nominated person on duty who knows, or can find out, the ingredients of all
  dishes.
• Encourage serving staff to make all enquiries to that staff member. Impress on them how important this is.
• Ask suppliers to provide accurate written details about all ingredients, including any planned changes.
• Try to avoid the indiscriminate use of nuts, e.g. powdered nuts as a garnish, unless this is an essential
  part of the recipe.
• If a dish is meant to contain nuts, why not make sure this is reflected in the name: e.g. Nut & Carrot
  salad.
• If possible, keep certain preparation areas designated as nut free areas.
• Put up a prominent sign encouraging people with allergies to question staff.
• Include a prominent statement on the menu encouraging customers with severe allergies to question staff. For example, this could state: "Some of our dishes contain nuts. If you are allergic to nuts, please, ask the waiter to suggest a nut-free meal"
• Try to ensure that where a dish contains potent allergens - particularly nuts - this is indicated in some
  way on the menu. Some restaurants adopt a circled "N".
• Organise for your staff a training session on allergies. Make sure that all new staff members (including
  part-time and casual staff) are aware of the serious allergies.

New rules establish a list of 12 food allergens that must be listed whenever they, or ingredients made from them, are used at any level in pre-packed foods including alcoholic drinks. These foods are gluten, crustaceans, eggs, fish, peanuts, nuts, soybeans, milk, celery, mustard, sesame and sulphur dioxide.

Guidance for serving staff

• If a customer claims to have life-threatening food allergy (Anaphylaxis), take the customer seriously.
  Peanuts and Tree nuts (Almond, Brazil, Walnut and Hazelnut) are the foods most commonly implicated.
  But on rare occasions other foods may be mentioned. These may include sesame seeds and other
  seeds, dairy products, eggs, soya, shellfish, fish, pulses and fresh fruit.
• Find out which member of staff has access to accurate information about ingredients. Approach that
  person if you need the information.
• If there is any doubt about whether a food is free from of a certain ingredient admit to the customer that
  you are unsure.
• If on examining his meal, a customer realises it contains nuts and asks you to replace it, remember it is
  not enough simply to pick the nuts from the plate and return it to the customer. Tiny traces that remain
  may be enough to cause a severe reaction.
• If there is a gateau covered in nuts on the sweet trolley, ensure that no nuts could possibly be transferred
  to adjacent sweets.

Specific Points for ALL staff

• Remember that cooking in unrefined groundnut oil (Peanut oil) may leave traces of nut protein in the food being cooked.
• ANY oil that has previously been used to cook products containing nuts may contain traces of nut
  proteins.
• If you are preparing food for someone with a severe allergy, beware of transferring food from one dish to
  another.
• Remember that salad oil may be derived from nut oil.
• Hands, utensils, cutlery and work surfaces should be washed scrupulously after handling foods
  containing nut protein allergens.

Emergency Action

If an allergic customer becomes ill, it is likely that person - or someone with them - will state that he/she is suffering an allergic reaction. They may use the word "ANAPHYLAXIS"

This is what to do:-

• Immediately send someone to dial 999 giving the following information:

"THIS IS AN EMERGENCY. A CUSTOMER HAS COLLAPSED AND WE BELIEVE THEY ARE
SUFFERING FROM ANAPHYLAXIS." (Pronounced ANA-FILL-AXIS)

SPEAK CLEARLY SO THAT THE AMBULANCE CREW WILL KNOW EXACTLY WHERE TO COME.

• Someone should be sent to stand at the entrance to direct the ambulance crew to the patient.
• Ask other customers if there is a Doctor in the Restaurant.

Any staff trained in First Aid should make a point of learning what to do if someone suffers from Anaphylaxis.

Please remember death can take place within 10 minutes. Prompt and immediate action is vital.

Updated 8/2008