Food Allergies and Menu Planning for Schools and Child Care

1. Food Allergies and Menu Planning for Schools and Child Care Lynn James, M.S., R.D., L.D.N. Janice Ronan Fran Alloway, M.A., R.D., L.D.N. Penn State Cooperative Extension

2. Overview of Objectives • What is an allergy? • Control of allergens • Allergen regulations • What you can do • Food Allergy Action Plan

3. Food Allergy vs. Intolerances • Food Allergy- involves the body’s immune system • Food Intolerance- does not involve the body’s immune system

4. What is a Food Allergy? • Food Allergy: The body’s adverse reaction to food caused by the immune system of sensitive individuals • Allergen (food protein) : The substance that causes the adverse reaction

5. Symptoms of a Food Allergy Within 2 minutes -2 hours of eating the food, body’s cells make Histamine that can cause: • Itching in mouth • Stomach cramps, diarrhea, vomiting • Blood pressure drops • Skin hives or eczema, dermatitis • Asthma in lungs • Death by anaphylactic shock (nuts leading cause) Over 160 foods are identified as causing food allergies, but 8 are the most common:

7. Who Has Food Allergies? • 1/3 think they or a family member have a food allergy Research states: • 2-4 % adults; 5-8 % infants and young children • Approximately 30,000 consumers require emergency room treatment yearly • 150 Americans die each year because of allergic reactions to food.

8. Food Allergies • Symptoms can worsen after each exposure • So far, cannot be “cured” but can be outgrown • Percent of children who outgrow: milk, egg, soy – 50 - 80% peanut, tree nuts and shellfish -15 - 20%

9. Food Allergy Prevention 1. Breastfeeding Exclusive breastfeeding for first 4 mo. Feeding hypoallergenic formulas if not breastfed – some evidence 2. For Families with Food Allergies, Infant feeding Guidelines: • Delay introducing solid food until 4-6 mo. • Not conclusive that avoiding allergens early prevents allergies Source: American Academy of Allergy, Asthma, & Immunology www.aaai.org ; American Academy of Pediatrics

10. Allergy Issues Cross-Reactivity- allergy crosses over to like allergens- • e.g. different kinds of nuts • shrimp, crab, lobster, crayfish Oral Allergy Syndrome- a kind of cross-reactivity, severe mouth itching • e.g. ragweed & melons • birch and apple peels

11. “Undercover” Allergens • Soy • Lecithin, hydrolyzed plant proteins • Wheat • Starch, flour, gluten • Dairy • Whey, sodium caseinate • Egg • Albumin

12. Medical Interventions Epinephrine (adrenaline) The drug of choice for treatment of anaphylaxisis Should be followed by trip to hospital Antihistamines Storing medication

13. Food Intolerances Lactose Intolerance Body lacks lactase enzyme to digest milk sugar • Affects 10% population • Foods: milk, soft cheese, ice cream • Causes gas, bloating, abdominal pain, sometimes diarrhea

14. Gluten Intolerance Or Celiac Disease- bodyreacts to gluten- proteins in wheat, barley, and rye. • May affects 1 in 133 • Causes severe intestinal problems/malabsorption

15. Food Intolerances Food Additives-often confused with food allergy, some can cause problems in sensitive individuals: • MSG- monosodium glutamate- flavor enhancer in many foods • Sulfites -Sulfur-based compounds that may occur naturally or may be added as a preservative.

16. Some foods sources of sulfites • Baked goods • Soup mixes • Canned or frozen fruits and vegetables • Dried fruit • Trail mix • Potato chips • Jams • Fresh or frozen shrimp • Molasses

17. Some food sources of sulfites • Alcohol, beer, and wine • Sparkling grape juice • Apple cider • Bottled lemon juice and lime juice • Tea • Many condiments • Maraschino cherries • Dehydrated, pre-cut or peeled potatoes

18. Food Allergen Labeling and Consumer Protection Act of 2004(FALCPA) Requires that the label of all packaged food sold in the US under FDA that contains an ingredient that is or contains protein from a “major food allergen” must display a “Contains” statement OR plain English labeling of allergens in ingredient statement OR both Currently no thresholds for allergens Effective for food products labeled on or after January 1, 2006—domestic and imported.

19. FALCPA Requirements • Declare food allergens on label • Manufacturers and processors must ensure no undeclared allergens from: • Ingredients • Processing aids • Cross-contamination-food allergen from one food inadvertently gets into another food

20. How have food labels changed? Labeling Option 1: Name food source after name of ingredient Ingredients: Enriched flour (wheat flour, malted barley, niacin, folic acid), sugar, whey (milk),eggs . . . . . lecithin (soy).

21. How have food labels changed? Option #2 Found near ingredient list on label: Contains wheat, milk, eggs, and soy.

22. Contains statement FALCPA Compliant Label Allergens

23. Enforcement? • Enforced by FDA as part of its routine regulation and inspection. • Applies to packaged FDA regulated foods. • Does not apply to foods wrapped or packaged at the request of the consumer (bakery, doggie bags)

24. Legal Issues for Child Care Providers Children with potentially life-threatening food allergies may be considered disabled and covered by federal laws: • Rehabilitation Act of 1973, Section 504 Preschools and child care centers that receive federal funds or services must comply. • Americans with Disabilities Act of 1990 Titles II and III may impact centers run by state or local governments and private centers.

25. Legal Issues Liability waivers are of little use. Parents cannot enter into an agreement that denies their children necessary care and protection.

26. How Can Child Care/SchoolSites Manage Food Allergies?

27. Managing Food Allergies • Become educated about foods that contain the problem allergens. • Work together as a team with parents, staff and food service • Have an Allergy Action Plan in place

28. Education is the best way to manage your liability and minimize risks to children. Work together with • Child’s parents • Child’s physician • Staff-teachers and food service • School nurses, emergency medical personnel

29. Looking At Your Menu • Which foods include the problem allergen? • Can substitutions be provided? • Can ingredients be changed? • Will cross contamination be a problem? • Should you eliminate that food from menu? • Non-allergenic snacks

30. Preventing Problems with Food Allergens Avoid Cross-contamination: • clean hands with soap and water between tasks • clean and sanitize work surfaces and utensils • Frequently check food labels for food allergens and cross-over foods that may carry allergens- eg peanut oil

31. Day to Day Strategies • Frequently read labels • Prepare allergy-free foods first • Prevent Cross Contamination • Prepare allergy-free foods in large quantities and freeze • Prepare a policy on preventing cross contamination and food allergies, train staff

32. Resources Food Allergy & Anaphylaxis Network (FAAN) Fairfax, VA 800-929-4040 www.foodallergy.org FDA: Information about Food Allergies National Library of Medicine: MedlinePlus Food Allergy International Food Information Council (IFIC)

33. References • http://www.niaid.nih.gov/publications/pdf/foodallergy.pdf • http://www.datcp.state.wi.us/fs/business/food/training/allergens.jsp • US Food & Drug Administration, Information for Consumers: Food Allergen Labeling And Consumer Protection Act of 2004Questions and Answers, December 12, 2005; Updated July 18, 2006

34. Food Allergies and Menu Planning for Schools and Child Care Prepared by: Lynn James, M.S., R.D., L.D.N. Janice Ronan Frances Alloway, M.A., R.D., L.D.N. Extension Educators, Penn State Cooperative Extension

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