from delivery to dining: components of an e ective food...

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From Delivery to Dining:Components of an Effective Food

Allergen Control Plan

Bonnie Johnson, MS, RD


Objectives

• List the critical points of a food allergen control plan.

• Explain the need for a food allergen control plan and the consequences of not following it.

• Assemble a multidisciplinary team to develop a food allergen control plan.

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Food Allergy: A Growing Topic

• 5% of children and 4% of adults have a food allergy (1). While anyone can be allergic to any food, there are eight foods that cause 90% of allergic reactions (2).

• Allergy prevalence among US population (1):– Dairy 2.5%– Fish & Shellfish 2.4%– Egg 1.3%– Peanut 0.6%– Tree Nuts 0.5%– Soy 0.4%– Wheat 0.4%

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Food Allergens are on the Menu

• http://www.wordle.net/show/wrdl/3643139/SchoolMenus

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http://www.wordle.net/show/wrdl/3643139/SchoolMenus





Food Allergy: Reactions

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• A food allergy is an immune reaction (usually to a protein) that can manifest in different ways.

ANY FOOD CAN CAUSE AN ALLERGIC REACTION• Reactions are unpredictable. (8)• The severity of a reaction is dependent on many factors.(8)• An allergic reaction to food can take place within a few minutes to an hour.

• An allergic reaction can cause a wide array of symptoms. (1)• Anaphylaxis is the most severe reaction.(1)• A food intolerance is NOT the same as an allergy.

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Food Allergy: Reactions

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• Ingestion: Severe reactions can occur when an allergen is ingested. Symptoms generally involve the GI system such as vomiting, diarrhea, or pain. In rare cases ingestion can cause anaphylaxis. (1)

• Skin Contact: Cannot cause anaphylaxis. Most reactions are localized to the point of contact like a rash or hives. (9)

• Smelling/Inhalation: Cannot cause anaphylaxis. Most reactions include sneezing, running nose and coughing. (9)




Food Allergen Control:Protects Customers, Protects You

• Assemble a team• Conduct an assessment & prioritize• Develop an allergen process flow diagram• Review regularly

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The Team• Ordering

– labeling– certification

• Warehouse– receiving– storage

• Preparation– ingredients– equipment

• Service– recipes– caution

• Engineering– cleaning – sanitization

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Risk Assessment & Allergen Map

• Scavenger hunt– Find every possible allergen and tag with a sticky note

• Review purchasing log for allergens that may not be present at the time

• Take each allergen on its usual path through your operation– From door to floor

• Make a map for each allergen then lay them over each other

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Allergen Map

• Use overlay map to create an allergen -free zone and/or an allergen only area.

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Purchasing & Receiving• Ask suppliers for their allergen control plan• Question suppliers on ingredients and product labels.

– Renovations happen all the time, be aware when allergens are added or removed from commonly used ingredients/products

– Audit suppliers – Ask suppliers to clearly mark all containers

• Review labels of incoming materials.• Tag each case/pallet/bag with allergen to clearly identify ingredients.

– Color code• Do not accept damaged containers when potential cross-contact

with allergens may have occurred.

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Storage• Store allergenic ingredients/products

separately to prevent cross-contact:– Use clean & closed containers– Designate separate storage areas for

allergenic and non-allergenic ingredients• If not possible, prevent cross-contact by

implementing other policies:– Don’t store allergens OVER non-allergens– Use dedicated pallets and bins

– Document clean-up procedures for spills or damaged containers of allergens

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Preparation

• Create a schedule– prepare items with allergenic ingredients at

the end– designate employees to work only with

allergens or non-allergen products– sanitize immediately after preparing a food

with an allergen• Create a space

– designate an area for preparing foods with allergens

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Preparation• Designate equipment for preparing foods with allergens

– Use a color coded system on equipment too– If not possible, implement strict sanitization

procedures• Using the allergen map to reduce the traffic of raw

materials thru the space when allergens are being prepared

• Prepare like allergen foods together• Don’t reuse water or oil after allergen has be come in

contact with it.

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Service• Clearly identify menu items that contain allergens (all

allergens)– Use color codes

• Instruct service staff on presence of allergens before each service– Designate a “go-to” person

• All employees must feel comfortable saying “I don’t know”. Even after consulting with a manager about the details if you have doubts about whether a product is safe, BE HONEST!

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Clean-Up

• Protocols for cleaning allergen-prep areas and equipment should be clearly written and easy to follow and understand.– What is to be cleaned & sanitized– Who is responsible for cleaning & sanitizing– When to clean & sanitize– What to use to clean– Train on proper procedures

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Cleaning Procedure• Pre-cleaning – Scrape and rinse to remove loose

food.• Wash - Use detergent solutions to remove stuck-on

food.• Detergent MUST be used to deactivate the protein

that is the allergen.

• Most household cleaners will work (Formula 409, Lysol, Target cleaner with bleach)

• Except dishwashing liquid and antibacterial products

• Sanitizing solution is NOT enough. • Rinse to remove food and detergent.• Sanitize to kill attached surviving bacteria and viruses.

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Clean at Every Step• Lifting peanut butter cookies from baking sheet with a

spatula and then using the same spatula to lift sugar cookies.

• Using a knife to make peanut butter sandwiches, wiping the knife and then using that same knife to spread mustard on a peanut allergic child’s cheese sandwich.

• Thoroughly clean and then sanitize food contact surfaces of equipment and utensils such as slicer blades and can openers, if it has been used for items that contain allergens.

• Wash and then sanitize trays or baking sheets after each use. Oils containing allergens can seep through paper pan liners and contaminate the next food item place on the sheet or tray.

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Training

• All staff should receive general training on food allergen awareness and control.– Including what an allergic reaction looks like

and how to respond• Call out the reasons protocols are required

and the potential consequences should the plan is not be followed.

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Reminders• Any food can trigger an allergic reaction for

someone who is allergic.• Even trace amounts of an allergen can cause an

allergic reaction in highly sensitive people.– There is no test to see how sensitive people

are.• Take all food allergies seriously.• Treat all customer with food allergies with

respect and understanding.• Be honest...err on the side of caution.

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Responding to An Allergic Reaction

• Many of your customers who have people a severe food allergies will NOT carry portable injectable epinephrine.

• Know where the “epi-pen” is in your school.• Fight to have an “epi-pen” or two in your operation.• Regulations vary by state• Work with the school nurse • It IS your responsibility to be able to respond to any kind

of medical emergency.• Have emergency medical numbers posted near every

phone.• Train staff to respond quickly in an emergency.• Never second guess an emergency.

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References

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1. National Institute of Allergy and Infectious Diseases: www3.niaid.nih.gov 2. Sampson HA. Update on food allergy. J Allergy Clin Immunol; 113:805-19. 2004. 3. CDC NCHS Data Brief. Food Allergy Among U.S. Children: Trends in Prevalence and Hospitalizations. 2008. 4. Strachan DP . Family size, infection and atopy: the first decade of the "hygiene hypothesis. Thorax 55 Suppl

1: S2–10.5. Seitz, C. Pfeuffer, P. Food allergy in adults: an over- or underrated problem? Deutsches Arzteblatt Int. 2008. 6. Lack, G. Epidemiologic risks for food allergy. JACI 2008. 7. Noverr , M. Falkowski , N. Development of Allergic Airway Disease in Mice following Antibiotic Therapy and

Fungal Microbiota Increase: Role of Host Genetics, Antigen, and Interleukin-13. Infection & Immunity: 73(1), January 2005 .

8. Food allergy myths. The Food Allergy and Anaphylaxic Network. Faan.org/page/myths9. Simonte, S. Relevance of casual contact with peanut butter in children with peanut allergy. JACI 2003.10. Ross MP. Analysis of food-allergic and anaphylactic events in the National Electronic Injury Surveillance

System. JACI 2008.11. Clark, S. Multicenter study of emergency department visits for food allergies. JACI. 2004.12. Colver, AF. Sever food-allergic reactions in children across the UK and Ireland. 1998-200. Aeta Paediatr.

2005. 13. Moneret-Vautrin. Food allergy to peanut in France: evaluation of 142 observations. Clin Exp Allergy 1998.14. Bock SA. The natural history of peanut allergy. J Allergy Clin Immunol. 1989. 15. Jensen, L. Peanut cross-reacting allergens in seeds and sprouts of a range of legumes. Clinical & Ex Allergy.

2008. 16. Clark AT, Eewan PW. The development and progression of allergy to multiple nuts at different ages. Pediatr

Allergy Immunol 2005; 16: 507-511. 17. Hofmann, A. Safety of a peanut oral immunotherapy protocol in children with peanut allergy. JACI 2009. 18. Li, Miu-Min. Efficacy and mechanisms of action of traditional Chinese medicines for treating asthma and

allergy. JACI 2008. 19. Du Toit. Early Consumption of Peanuts in Infancy is Associated with a Low Prevalence of Peanut Allergy.

JACI 2008.



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